Healthcare Provider Details

I. General information

NPI: 1225060148
Provider Name (Legal Business Name): JAMES BRUCE CARROLL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 N MITCHELL AVE
BAKERSVILLE NC
28705-6502
US

IV. Provider business mailing address

PO BOX 27
BAKERSVILLE NC
28705-0027
US

V. Phone/Fax

Practice location:
  • Phone: 828-688-2104
  • Fax: 828-688-1334
Mailing address:
  • Phone: 828-688-2104
  • Fax: 828-688-1334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number31781
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: