Individual
MR. FRED CARTER EWALT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2080 CHILD ST, JACKSONVILLE, FL 32214-5005
(904) 542-7765
(904) 542-7835
Mailing address
2080 CHILD ST, JACKSONVILLE, FL 32214-5005
(904) 542-7765
(904) 542-7835
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1462446
FL
Other
Enumeration date
02/23/2006
Last updated
11/10/2009
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