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General NPI Number Information
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NPI Number | 1245234012
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Entity Type | Individual
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Provider Name | CARLOS R. TANDRON M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/09/2005
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Last Update Date | 12/08/2023
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Provider Practice Location Address
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Address Line | 1325 SAN MARCO BLVD SUITE 200
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8559
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Country | US
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Telephone | 904-346-3465
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Fax | 904-858-6489
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Provider Business Mailing Address
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Address Line | PO BOX 40767
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City | JACKSONVILLE
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State | FL
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Zip | 32203-0767
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Country | US
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Telephone | 904-376-3707
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Fax | 904-391-5001
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | ME56140
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | ME56140
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number | ME56140
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License Number State | FL
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