Healthcare Provider Details

I. General information

NPI: 1649293689
Provider Name (Legal Business Name): JAMES MICHAEL CARROLL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 CALIFORNIA ST
HOUSTON TX
77006-2602
US

IV. Provider business mailing address

PO BOX 66308
HOUSTON TX
77266-6308
US

V. Phone/Fax

Practice location:
  • Phone: 832-548-5000
  • Fax: 832-548-5092
Mailing address:
  • Phone: 832-548-5000
  • Fax: 713-559-3255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberM7087
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: