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General NPI Number Information
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NPI Number | 1780769281
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Entity Type | Individual
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Provider Name | BENJAMIN JOSEPH CARROLL D.O.
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Gender | Male
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 02/23/2012
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Provider Practice Location Address
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Address Line | 200 E WASHINGTON ST DEPARTMENT OF ANESTHESIOLOGY (AAA)
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City | APPLETON
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State | WI
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Zip | 54911-5490
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Country | US
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Telephone | 920-996-1352
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Fax |
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Provider Business Mailing Address
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Address Line | 200 E WASHINGTON ST DEPARTMENT OF ANESTHESIOLOGY (AAA)
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City | APPLETON
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State | WI
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Zip | 54911-5490
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Country | US
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Telephone | 920-996-1352
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Fax |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 49666-021
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License Number State | WI
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