Healthcare Provider Details

I. General information

NPI: 1144600016
Provider Name (Legal Business Name): JAMES ANDREW CARROLL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 01/30/2026
Certification Date: 01/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S NEW BALLAS RD STE 2016B
SAINT LOUIS MO
63141-8265
US

IV. Provider business mailing address

621 S NEW BALLAS RD STE 2016B
SAINT LOUIS MO
63141-8265
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-5860
  • Fax: 314-251-5861
Mailing address:
  • Phone: 314-251-5860
  • Fax: 314-251-5861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number30497
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2022015510
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number2022015510
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: