Provider Demographics
NPI:1568448181
Name:MCCARROLL, KERRY D (MD)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:D
Last Name:MCCARROLL
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:PO BOX 1968
Mailing Address - Street 2:
Mailing Address - City:ALVIN
Mailing Address - State:TX
Mailing Address - Zip Code:77512-1968
Mailing Address - Country:US
Mailing Address - Phone:281-331-0082
Mailing Address - Fax:281-331-4802
Practice Address - Street 1:400 MEDIC LN STE C
Practice Address - Street 2:
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-5567
Practice Address - Country:US
Practice Address - Phone:281-331-0082
Practice Address - Fax:281-331-2624
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9797207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80520NMedicare ID - Type UnspecifiedMEDICARE ID NUMBER
TXC19034Medicare UPIN