MEDICARE: CASEY TERRY CARR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LC0200X	Critical Care Medicine (Anesthesiology) Physician	ME139535	FL
2	207P00000X	Emergency Medicine Physician	ME139535	FL
3	207P00000X	Emergency Medicine Physician	44869	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417342007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASEY TERRY CARR

Provider Business Mailing Address
First Line	:	PO BOX 44008
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32231-4008
Country	:	US
Telephone Number	:	904-244-6340
Fax Number	:

Provider Business Practice Location Address
First Line	:	655 W 8TH ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-6511
Country	:	US
Telephone Number	:	904-244-6340
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2015
Last Update Date	:	02/25/2026

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Directions to “ CASEY TERRY CARR ” Practice Location

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