Provider Demographics
NPI:1003879131
Name:DELLOCK, CAREY A (MD)
Entity Type:Individual
Prefix:
First Name:CAREY
Middle Name:A
Last Name:DELLOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2631 CENTENNIAL BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-0591
Mailing Address - Country:US
Mailing Address - Phone:850-656-7265
Mailing Address - Fax:850-702-0245
Practice Address - Street 1:2631 CENTENNIAL BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-0588
Practice Address - Country:US
Practice Address - Phone:850-656-7265
Practice Address - Fax:850-702-0245
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME110641207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003931600Medicaid
FLFH133ZOtherMEDICARE PTAN
FL003931600Medicaid
PA054758Medicare PIN
FLH56015Medicare UPIN