Provider Demographics
NPI:1154407393
Name:HIDALGO, CARLOS A JR (MD)
Entity type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:A
Last Name:HIDALGO
Suffix:JR
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 1:1007 EAST BOYER ST
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689
Mailing Address - Country:US
Mailing Address - Phone:727-772-5982
Mailing Address - Fax:727-772-0693
Practice Address - Street 1:1007 EAST BOYER ST
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689
Practice Address - Country:US
Practice Address - Phone:727-772-5982
Practice Address - Fax:727-772-0693
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0055862208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAH2048608OtherDEA
B16874Medicare UPIN