Basic Information
| Provider Information | |||||||||
| NPI: | 1609860444 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARMAIN | ||||||||
| FirstName: | TORR | ||||||||
| MiddleName: | ERIK | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 403 W HIGHLAND BLVD | ||||||||
| Address2: | |||||||||
| City: | INVERNESS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344524717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527263646 | ||||||||
| FaxNumber: | 3527260079 | ||||||||
| Practice Location | |||||||||
| Address1: | 403 W HIGHLAND BLVD | ||||||||
| Address2: | |||||||||
| City: | INVERNESS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344524717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527263646 | ||||||||
| FaxNumber: | 3527260079 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2005 | ||||||||
| LastUpdateDate: | 02/10/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 03/25/2006 | ||||||||
| NPIReactivationDate: | 04/03/2006 | ||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | ME110604 | FL | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 003581700 | 05 | FL | MEDICAID |