Healthcare Provider Details

I. General information

NPI: 1790797090
Provider Name (Legal Business Name): JOSE A CARRION MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 PINE GROVE AVE STE 7
PORT HURON MI
48060
US

IV. Provider business mailing address

1530 PINE GROVE AVE STE 7
PORT HURON MI
48060
US

V. Phone/Fax

Practice location:
  • Phone: 810-985-0029
  • Fax: 810-985-3200
Mailing address:
  • Phone: 810-985-0029
  • Fax: 810-985-3200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number041277
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: