MEDICARE: DR. JOSEPH L CARRASCO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME070698	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110232500	OTHER	FL	MEDICARE RAILROAD

General Provider Information

NPI Number	:	1174610067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH L CARRASCO M.D.

Provider Business Mailing Address
First Line	:	26540 AVE AVE
Second Line	:	STE A
City	:	LEESBURG
State	:	FL
Zip	:	34748
Country	:	US
Telephone Number	:	352-307-6278
Fax Number	:	407-627-0205

Provider Business Practice Location Address
First Line	:	26540 AVE AVE
Second Line	:	STE A
City	:	LEESBURG
State	:	FL
Zip	:	34748
Country	:	US
Telephone Number	:	352-307-6278
Fax Number	:	407-627-0205

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	04/10/2026

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