MEDICARE: BRANT F CARROLL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	MD00036720	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	180036318	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0126806	OTHER	WA	LABOR & INDUSTRIES
2	CA3570	OTHER		REGENCE HEALTHCARE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154307999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANT F CARROLL M.D.

Provider Business Mailing Address
First Line	:	1101 MADISON ST
Second Line	:	SUITE 600
City	:	SEATTLE
State	:	WA
Zip	:	98104-1306
Country	:	US
Telephone Number	:	206-215-2004
Fax Number	:	206-215-2055

Provider Business Practice Location Address
First Line	:	1455 NW LEARY WAY
Second Line	:	SUITE 300
City	:	SEATTLE
State	:	WA
Zip	:	98107-5124
Country	:	US
Telephone Number	:	206-784-3350
Fax Number	:	206-781-8693

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	04/23/2014

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