Provider Demographics
NPI:1437121597
Name:CARROLL, MARK PHILP JR (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:PHILP
Last Name:CARROLL
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:9320 GRAND CORDERA PARKWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80924
Mailing Address - Country:US
Mailing Address - Phone:719-282-6337
Mailing Address - Fax:719-282-0532
Practice Address - Street 1:9320 GRAND CORDERA PARKWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80924
Practice Address - Country:US
Practice Address - Phone:719-282-6337
Practice Address - Fax:719-282-0532
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2019-12-18
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Provider Licenses
StateLicense IDTaxonomies
CODR.0045118207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine