Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | ME82442 | FL |
NPI | 1114912763 |
---|---|
Provider Name | Carolyn M Carey |
First Address | St Petersburg, FL 33701-4804 |
Second Address | St Petersburg, FL 33701-4804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2005 |
Last Update Date | 01/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
261293300 | (05) | FL |
34265 | BC/BS (01) | |
F03489 | (02) |