Provider Demographics
NPI:1780797100
Name:CARROLL, JAMES FORREST (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:FORREST
Last Name:CARROLL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:421 MARCH AVE STE D
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-3367
Mailing Address - Country:US
Mailing Address - Phone:707-433-3321
Mailing Address - Fax:707-433-0347
Practice Address - Street 1:421 MARCH AVE STE D
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-3367
Practice Address - Country:US
Practice Address - Phone:707-433-3321
Practice Address - Fax:707-433-0347
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA25507207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A25507Medicaid
CA00A25507Medicaid
CAA24471Medicare UPIN