Organization
RAUL CARRILLO MD PA
Active
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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