MEDICARE: DR. CRAIG GRASON CARROLL 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	2084N0400X	Neurology Physician	DR.55838	CO
2	204R00000X	Electrodiagnostic Medicine Physician	0055838	CO
3	2084N0400X	Neurology Physician	H0061118	MD
4	2084N0600X	Clinical Neurophysiology Physician	OS13733	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0055838	OTHER	CO	LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861479628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG GRASON CARROLL D.O

Provider Business Mailing Address
First Line	:	1908 THOMES AVE STE 12550
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82001-3527
Country	:	US
Telephone Number	:	757-282-3953
Fax Number	:

Provider Business Practice Location Address
First Line	:	1511 ONYX CIR
Second Line	:
City	:	LONGMONT
State	:	CO
Zip	:	80504-7805
Country	:	US
Telephone Number	:	303-776-5298
Fax Number	:	303-682-2785

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

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	10/20/2025

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