Healthcare Provider Details

I. General information

NPI: 1053932053
Provider Name (Legal Business Name): RACHEL CARROLL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2020
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32135 CASTLE CT STE 101
EVERGREEN CO
80439-8006
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 303-679-8500
  • Fax: 303-679-8505
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0071465
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: