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General NPI Number Information
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NPI Number | 1669532008
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Entity Type | Individual
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Provider Name | STEPHEN BRENT CARROLL M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 01/12/2023
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Provider Practice Location Address
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Address Line | 4411 THE 25 WAY NE SUITE 150
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-5857
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Country | US
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Telephone | 505-332-6919
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Fax | 505-332-6921
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Provider Business Mailing Address
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Address Line | 4411 THE 25 WAY NE SUITE 150
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-5857
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Country | US
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Telephone | 505-332-6919
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Fax | 505-332-6921
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME160184
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 35.134086
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | MD2013-0668
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License Number State | NM
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Taxonomy #4
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | A83492
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License Number State | CA
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