Provider Demographics
NPI:1003918673
Name:CARROLL, CHRISTOPHER PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:PATRICK
Last Name:CARROLL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9400 TURKEY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-8001
Mailing Address - Country:US
Mailing Address - Phone:321-843-5500
Mailing Address - Fax:321-843-5550
Practice Address - Street 1:9400 TURKEY LAKE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8001
Practice Address - Country:US
Practice Address - Phone:321-843-5500
Practice Address - Fax:321-843-5550
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95430207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00804053OtherMEDICARE RR
GA467041573AMedicaid
FL009366300Medicaid
FLU8431WMedicare PIN
FLP00804053OtherMEDICARE RR
GA467041573AMedicaid
FLP00804053OtherMEDICARE RR