Provider Demographics
NPI:1114065166
Name:KARR, MICHAEL RAY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:RAY
Last Name:KARR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2398 HARTFORD DR
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-9523
Mailing Address - Country:US
Mailing Address - Phone:863-453-2500
Mailing Address - Fax:863-453-0745
Practice Address - Street 1:2398 HARTFORD DR
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-9523
Practice Address - Country:US
Practice Address - Phone:863-453-2500
Practice Address - Fax:863-453-0745
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA1725363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL82933AOtherBCBS OF FL
FL660069700Medicaid
FL290263000Medicaid
FL103905Medicare UPIN
FLE34977Medicare UPIN
FL290263000Medicaid