Provider Demographics
NPI:1295817849
Name:CAROLAN, JOHN AUGUST (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:AUGUST
Last Name:CAROLAN
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 1:5632 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-2444
Mailing Address - Country:US
Mailing Address - Phone:520-790-8888
Mailing Address - Fax:520-790-1427
Practice Address - Street 1:5632 E 5TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2444
Practice Address - Country:US
Practice Address - Phone:520-790-8888
Practice Address - Fax:520-790-1427
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2009-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22587207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ190512Medicaid
A73163Medicare UPIN
70472Medicare ID - Type Unspecified