Provider Demographics
NPI:1063468932
Name:CARROLL, JOHN ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANTHONY
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 1:8328 E HARTFORD DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-6520
Mailing Address - Country:US
Mailing Address - Phone:480-214-9720
Mailing Address - Fax:480-214-9722
Practice Address - Street 1:8328 E HARTFORD DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-6520
Practice Address - Country:US
Practice Address - Phone:480-214-9720
Practice Address - Fax:480-214-9722
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18950207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ294611Medicaid
AZZ134014Medicare PIN
AZZ23695Medicare PIN
E85967Medicare UPIN