Provider Demographics
NPI:1124647326
Name:LINARES, CARLOS EDUARDO (MD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:EDUARDO
Last Name:LINARES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3236 N POINCIANA BLVD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-4688
Mailing Address - Country:US
Mailing Address - Phone:407-635-5954
Mailing Address - Fax:321-841-6904
Practice Address - Street 1:3236 N POINCIANA BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-4688
Practice Address - Country:US
Practice Address - Phone:407-635-5954
Practice Address - Fax:321-841-6904
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME168985207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL123208500Medicaid