Provider Demographics
NPI:1376536995
Name:CARROLL, DANIEL JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JAMES
Last Name:CARROLL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1000 W PINHOOK RD
Mailing Address - Street 2:STE 310
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2460
Mailing Address - Country:US
Mailing Address - Phone:337-233-9900
Mailing Address - Fax:337-233-0770
Practice Address - Street 1:1000 W PINHOOK RD
Practice Address - Street 2:STE 310
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2460
Practice Address - Country:US
Practice Address - Phone:337-233-9900
Practice Address - Fax:337-233-0770
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA013365208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1198129Medicaid
LA5J451Medicare PIN
LA1198129Medicaid