Basic Information
| Provider Information | |||||||||
| NPI: | 1326298936 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARSON | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | BOX 100108 | ||||||||
| Address2: | 1600 SW ARCHER RD | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326100108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522735670 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1600 SW ARCHER RD | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326100108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522735670 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2008 | ||||||||
| LastUpdateDate: | 05/19/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | ME128369 | FL | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 255914 | NY | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0102X | ME128369 | FL | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2086S0102X | 036158339 | IL | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care |
ID Information
| ID | Type | State | Issuer | Description | 018203800 | 05 | FL | MEDICAID |