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NPI Code Detail

MEDICARE: DR. EVAN DEMETRIOS CARRATT M.D.

MEDICARE:  DR. EVAN DEMETRIOS CARRATT  M.D.
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
1208D00000XGeneral Practice Physician040883GA
2208D00000XGeneral Practice PhysicianME100038FL

General Provider Information

NPI Number : 1962579391
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EVAN DEMETRIOS CARRATT M.D.
Provider Business Mailing Address
First Line : 1243 S RIDGEWOOD AVE
Second Line :
City : DAYTONA BEACH
State : FL
Zip : 32114-6127
Country : US
Telephone Number : 386-252-2504
Fax Number :
Provider Business Practice Location Address
First Line : 1243 S RIDGEWOOD AVE
Second Line :
City : DAYTONA BEACH
State : FL
Zip : 32114-6127
Country : US
Telephone Number : 386-252-2504
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2006
Last Update Date : 03/07/2023

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Directions to “ DR. EVAN DEMETRIOS CARRATT M.D.” Practice Location

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