Provider Demographics
NPI:1225060148
Name:CARROLL, JAMES BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:BRUCE
Last Name:CARROLL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 27
Mailing Address - Street 2:
Mailing Address - City:BAKERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28705-0027
Mailing Address - Country:US
Mailing Address - Phone:828-688-2104
Mailing Address - Fax:828-688-1334
Practice Address - Street 1:86 N MITCHELL AVE
Practice Address - Street 2:
Practice Address - City:BAKERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28705-6502
Practice Address - Country:US
Practice Address - Phone:828-688-2104
Practice Address - Fax:828-688-1334
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31781207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC212036DOtherMEDICARE PIN
NC00513OtherBCBS
NC014MXOtherBCBS LABS
NC8907673OtherMEDCAID PHYSICIAN
NC8921331Medicaid
NC07673OtherBCBS PHYSICIAN
NC235013OtherMEDICARE PHYSICIAN
NC235013BOtherMEDICARE PHYSICIAN
NC3400011OtherMEDCAID
NC411013849OtherMEDICARE RAILROAD
NC8921331Medicaid
NC235013BOtherMEDICARE PHYSICIAN
NC340011Medicare Oscar/Certification