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General NPI Number Information
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NPI Number | 1952556821
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Entity Type | Organization
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Legal Business Name | RAUL CARRILLO MD PA
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Dates
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Enumeration Date | 11/19/2008
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Last Update Date | 08/29/2012
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Provider Practice Location Address
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Address Line | 929. N. HWY 27/441 SUITE 302
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City | LADY LAKE
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State | FL
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Zip | 32159
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Country | US
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Telephone | 352-391-1115
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Fax | 352-391-5206
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Provider Business Mailing Address
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Address Line | 929 N. HWY 27/441 SUITE 302
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City | LADY LAKE
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State | FL
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Zip | 32159-8999
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Country | US
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Telephone | 352-391-1115
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Fax | 352-391-5206
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Authorized Official
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Title or Position | CEO
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Name | DR. RAUL CARRILLO
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Credential | MD
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Telephone | 352-391-1115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | ME87534
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License Number State | FL
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