Provider Demographics
NPI:1205830908
Name:MCCARTHY, CARLTON R
Entity Type:Individual
Prefix:
First Name:CARLTON
Middle Name:R
Last Name:MCCARTHY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 KING ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4735
Mailing Address - Country:US
Mailing Address - Phone:904-421-5586
Mailing Address - Fax:904-389-6748
Practice Address - Street 1:1824 KING ST
Practice Address - Street 2:SUITE 200
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4735
Practice Address - Country:US
Practice Address - Phone:904-421-5586
Practice Address - Fax:904-389-6748
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2255363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE1596YMedicare PIN
FLS76064Medicare UPIN