Provider Demographics
NPI:1891141206
Name:CARRELL, JEAN BAPTISTE
Entity Type:Individual
Prefix:
First Name:JEAN BAPTISTE
Middle Name:
Last Name:CARRELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18629 E 50TH PL
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80249-8731
Mailing Address - Country:US
Mailing Address - Phone:651-278-3678
Mailing Address - Fax:
Practice Address - Street 1:18629 E 50TH PL
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80249-8731
Practice Address - Country:US
Practice Address - Phone:651-278-3678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver