Provider Demographics
NPI:1780993915
Name:JAMES F. CARROLL M.D. MEDICAL CORPORATION
Entity type:Organization
Organization Name:JAMES F. CARROLL M.D. MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:F
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-433-3321
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25507207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A255070Medicaid
00A255070OtherMEDICARE PTEN
CA00A255070Medicaid
00A255070Medicare PIN