Provider Demographics
NPI:1255422614
Name:MCCARROLL, GREGORY DUNCAN (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:DUNCAN
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 1:7622 LOUIS PASTEUR DR
Mailing Address - Street 2:STE. 100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4037
Mailing Address - Country:US
Mailing Address - Phone:210-614-7840
Mailing Address - Fax:210-614-6421
Practice Address - Street 1:7622 LOUIS PASTEUR DR
Practice Address - Street 2:STE. 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4037
Practice Address - Country:US
Practice Address - Phone:210-614-7840
Practice Address - Fax:210-614-6421
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5351207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX354622YLPSOtherWELLMED MEDICARE
TX1247207-05OtherWELLMED MEDICAID
TXE14323Medicare UPIN
TXE14323Medicare UPIN