Doctor Name: | DR. MATTHEW BERNARD CARROLL |
NPI Number: | 1124247341 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | MD-066108-L |
Business Practice Address: | 301 Fisher St Keesler Afb, MS - 395342508 |
Business Phone Number: | 2283771110 |
Business Fax Number: | |
Mailing Address: | 301 Fisher St, KEESLER AFB |
State: | MS |
Postal Code: | 395342508 |
Phone Number: | 2283763629 |
Fax Number: | |
NPI Enumeration Date: | 04/25/2007 |
NPI Last Update Date: | 11/13/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 171000000X |
License Number: | MD-066108-L |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Military Health Care Provider |
Taxonomy Specialization: | |
Taxonomy Definition: | Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |