Dethloff, Carver Gray

Dethloff, Carver Gray is an individual health care provider with primary practice located at 11 Racetrack Rd Ne Ste E4 , Fort Walton Beach FL 32547-1867. He recently has only one registered license in Speech, Language and Hearing Service Providers / Audiologist, which is considered as his primary health care specialty. Dethloff, Carver Gray can be contacted via phone (850) 315-4141.

Contact Information

Primary practice address
11 Racetrack Rd Ne Ste E4 Fort Walton Beach FL 32547-1867
Phone: (850) 315-4141
Fax: (850) 226-8242
Website:
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Health care specialties

SpecialtyCodeLicense #State
Speech, Language and Hearing Service Providers / Audiologist 231H00000X AY1018 Florida

Profile Details

NPI number 1194700922
LBN Legal business name Dethloff, Carver Gray
Credentials AU.D.
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 14th, 2005
Last updated Jul 21st, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1194700922 NPPES
Florida Other S9298 BCBS
Florida MEDICAID 600389300 BCBS

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