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General NPI Number Information
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NPI Number | 1619966744
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Entity Type | Individual
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Provider Name | RICHARD PEYTON CARROLL JR. D.O.
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Gender | Male
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Dates
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Enumeration Date | 10/20/2005
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Last Update Date | 06/26/2008
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Provider Practice Location Address
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Address Line | 14508 NE 20TH AVE SUITE 102
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City | VANCOUVER
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State | WA
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Zip | 98686-6424
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Country | US
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Telephone | 360-574-9730
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Fax | 360-576-7662
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Provider Business Mailing Address
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Address Line | 14508 NE 20TH AVE SUITE 102
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City | VANCOUVER
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State | WA
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Zip | 98686-6424
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Country | US
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Telephone | 360-574-9730
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Fax | 360-576-7662
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OP00002292
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License Number State | WA
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