Healthcare Provider Details

I. General information

NPI: 1174524987
Provider Name (Legal Business Name): RAMON LEONARD CARROLL JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 WEST CIRCLE DR
CLEWISTON FL
33440
US

IV. Provider business mailing address

224 WEST CIRCLE DR
CLEWISTON FL
33440
US

V. Phone/Fax

Practice location:
  • Phone: 863-301-5450
  • Fax: 863-301-5430
Mailing address:
  • Phone: 239-565-9437
  • Fax: 863-301-5430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME97506
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: