Individual
JERAL W CARR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1289 SW STATE ROAD 47, LAKE CITY, FL 32025-0484
(386) 755-0421
(386) 487-1234
Mailing address
1289 SW STATE ROAD 47, LAKE CITY, FL 32025-0484
(386) 755-0421
(386) 487-1234
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9102567
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
363A00000X
TAXONOMY CODE
FL
01
—
PA9102567
MEDICAL LICENSE #
FL
Enumeration date
04/14/2006
Last updated
12/11/2009
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