MEDICARE: MR. BARRY SCOTT CARROLL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	C8231	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	5J262B477	OTHER	AR	MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5J262	OTHER	AR	BLUECROSS ARKANSAS
2	P00014280	OTHER	AR	RAILROAD PIN
3	5532098	OTHER	AR	AETNA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669477469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BARRY SCOTT CARROLL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 808
Second Line	:
City	:	CLINTON
State	:	AR
Zip	:	72031-0808
Country	:	US
Telephone Number	:	501-745-6100
Fax Number	:	501-745-6128

Provider Business Practice Location Address
First Line	:	244 HIGHWAY 65 N
Second Line	:	SUITE 1
City	:	CLINTON
State	:	AR
Zip	:	72031-6390
Country	:	US
Telephone Number	:	501-745-6100
Fax Number	:	501-745-6128

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	04/20/2012

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Directions to “ MR. BARRY SCOTT CARROLL M.D.” Practice Location

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