Provider Demographics
NPI:1881213817
Name:CARROLL, ROBERT MORTON X (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MORTON
Last Name:CARROLL
Suffix:X
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 1:2241 CENTURY HL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-3506
Mailing Address - Country:US
Mailing Address - Phone:310-435-1772
Mailing Address - Fax:
Practice Address - Street 1:2241 CENTURY HL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-3506
Practice Address - Country:US
Practice Address - Phone:310-435-1772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC284292086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC28429OtherTHANKS