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NPI Code Detail

MEDICARE: WILLIAM DAVID CARROLL M.D.

MEDICARE: WILLIAM DAVID 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
1207R00000XInternal Medicine PhysicianA39947CA
2207RG0300XGeriatric Medicine (Internal Medicine) PhysicianA39947CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3110105821OTHERCARAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100A399470OTHERCABLUE SHIELD OF CALIFORNIA
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1922005891
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIAM DAVID CARROLL M.D.
Provider Business Mailing Address
First Line : 3536 MENDOCINO AVE
Second Line : STE 200
City : SANTA ROSA
State : CA
Zip : 95403-3634
Country : US
Telephone Number : 707-575-6049
Fax Number : 707-546-2188
Provider Business Practice Location Address
First Line : 3536 MENDOCINO AVE
Second Line : 300
City : SANTA ROSA
State : CA
Zip : 95403-3634
Country : US
Telephone Number : 707-546-2180
Fax Number : 707-546-2188
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2005
Last Update Date : 02/07/2012

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Directions to “ WILLIAM DAVID CARROLL M.D.” Practice Location

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