Healthcare Provider Details

I. General information

NPI: 1093840043
Provider Name (Legal Business Name): GERALD W CARVER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 US HIGHWAY 1 S SUITE B-1
ST AUGUSTINE FL
32086-3708
US

IV. Provider business mailing address

1955 US HIGHWAY 1 S SUITE B-1
ST AUGUSTINE FL
32086-3708
US

V. Phone/Fax

Practice location:
  • Phone: 904-209-6180
  • Fax: 904-209-6181
Mailing address:
  • Phone: 904-209-6180
  • Fax: 904-209-6181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberME40481
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: