Individual
HIRAM CARRASQUILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1325 SAN MARCO BLVD STE 200, CREDENTIALING DEPARTMENT, JACKSONVILLE, FL 32207-8566
(904) 346-3465
(904) 858-6475
Mailing address
1325 SAN MARCO BLVD STE 200, JACKSONVILLE, FL 32207-8566
(904) 202-1032
(904) 858-6475
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
ME67033
FL
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
Primary
ME67033
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
376097900
—
FL
Enumeration date
06/09/2005
Last updated
03/25/2021
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