MEDICARE: RICHARD PEYTON CARROLL JR. D.O.

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	207Q00000X	Family Medicine Physician	OP00002292	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619966744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD PEYTON CARROLL JR. D.O.

Provider Business Mailing Address
First Line	:	14508 NE 20TH AVE
Second Line	:	SUITE 102
City	:	VANCOUVER
State	:	WA
Zip	:	98686-6424
Country	:	US
Telephone Number	:	360-574-9730
Fax Number	:	360-576-7662

Provider Business Practice Location Address
First Line	:	14508 NE 20TH AVE
Second Line	:	SUITE 102
City	:	VANCOUVER
State	:	WA
Zip	:	98686-6424
Country	:	US
Telephone Number	:	360-574-9730
Fax Number	:	360-576-7662

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

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	06/26/2008

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