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General NPI Number Information
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NPI Number | 1790821122
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Entity Type | Individual
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Provider Name | RONALD EUGENE CARROLL M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 06/14/2022
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Provider Practice Location Address
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Address Line | 823 CENTER AVE
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City | PAYETTE
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State | ID
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Zip | 83661-2535
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Country | US
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Telephone | 208-642-3396
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Fax | 208-642-9060
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Provider Business Mailing Address
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Address Line | 823 CENTER AVE P.O. BOX 175
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City | PAYETTE
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State | ID
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Zip | 83661-2535
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Country | US
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Telephone | 208-642-3396
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Fax | 208-642-9060
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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 | M-4116
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License Number State | ID
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