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Organization

RAUL CARRILLO MD PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. RAUL CARRILLO MD (CEO)
(352) 391-1115
Entity
Organization

Contact information

Practice address
929. N. HWY 27/441, SUITE 302, LADY LAKE, FL 32159
(352) 391-1115
(352) 391-5206
Mailing address
929 N. HWY 27/441, SUITE 302, LADY LAKE, FL 32159-8999
(352) 391-1115
(352) 391-5206

Taxonomy

Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
ME87534
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
267028300
FL
Enumeration date
11/19/2008
Last updated
08/29/2012
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