Individual
CHARLES LOYD CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
4778 S SCATTERFIELD RD, ANDERSON, IN 46013-2908
(765) 646-6331
Mailing address
4778 S SCATTERFIELD RD, ANDERSON, IN 46013-2908
Taxonomy
Speciality
Code
Description
License number
State
202C00000X
Independent Medical Examiner Physician
02001626A
IN
207P00000X
Emergency Medicine Physician
Primary
02001626A
IN
207Q00000X
Family Medicine Physician
02001626A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000198187
BC/BS #
IN
01
—
080174096
RAILROAD
IN
05
—
200031800
—
IN
05
—
2000382
—
OH
Enumeration date
07/28/2005
Last updated
04/14/2023
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