Healthcare Provider Details

I. General information

NPI: 1528231610
Provider Name (Legal Business Name): ROBERT ALAN CARLTON AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 12/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 E EDGEWOOD DR
LAKELAND FL
33803-3412
US

IV. Provider business mailing address

1702 E EDGEWOOD DR
LAKELAND FL
33803-3412
US

V. Phone/Fax

Practice location:
  • Phone: 863-688-0777
  • Fax: 863-688-4443
Mailing address:
  • Phone: 863-688-0777
  • Fax: 863-688-4443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY 1272
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: