Provider Demographics
NPI:1316156755
Name:SUAREZ, CARLOS R (PA)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:R
Last Name:SUAREZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5080 SPECTRUM DR
Mailing Address - Street 2:SUITE 1200 WEST
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4648
Mailing Address - Country:US
Mailing Address - Phone:972-364-8000
Mailing Address - Fax:214-775-4502
Practice Address - Street 1:7800 NW 25TH ST
Practice Address - Street 2:SUITE 4
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33122-1625
Practice Address - Country:US
Practice Address - Phone:305-593-2174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2960363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE0784YMedicare UPIN
FLE0784WMedicare UPIN
FLBR885BMedicare PIN
FLBR885CMedicare PIN
FLBR885AMedicare PIN
FLE0784XMedicare UPIN