Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | ME110641 | FL |
NPI | 1003879131 |
---|---|
Provider Name | Carey A Dellock |
First Address | Tallahassee, FL 32308-0591 |
Second Address | Tallahassee, FL 32308-0588 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2006 |
Last Update Date | 27/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003931600 | (05) | FL |
FH133Z | MEDICARE PTAN (01) | FL |