Healthcare Provider Details

I. General information

NPI: 1881198497
Provider Name (Legal Business Name): DYLAN THOMAS CARROLL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4306 ALTON RD
MIAMI BEACH FL
33140-2840
US

IV. Provider business mailing address

4306 ALTON RD
MIAMI BEACH FL
33140-2840
US

V. Phone/Fax

Practice location:
  • Phone: 305-674-2177
  • Fax: 305-674-2176
Mailing address:
  • Phone: 305-674-2177
  • Fax: 305-674-2176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberME179849
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: