Organization
EMERALD COAST AUDIOLOGY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARVER GRAY DETHLOFF AUD (OWNER)
(850) 315-4141
Entity
Organization
Contact information
Practice address
11 RACETRACK RD NE STE E4, FORT WALTON BEACH, FL 32547-1867
(850) 315-4141
(850) 226-8242
Mailing address
11 RACETRACK RD NE STE E4, FORT WALTON BEACH, FL 32547-1867
(850) 315-4141
(850) 226-8242
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
AY1018
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
600389300
—
FL
01
—
S9298
BCBS
FL
Enumeration date
08/29/2006
Last updated
07/21/2020
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