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TANNON DAJUAN CARROLL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
301 SETON PKWY, SUITE 302, ROUND ROCK, TX 78665-8002
(512) 324-4812
(512) 324-4728
Mailing address
1400 N IH 35, SUITE 300, AUSTIN, TX 78701-1926
(512) 324-8300
(512) 324-8301

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
P7887
TX
207RI0011X
Interventional Cardiology Physician
Primary
P7887
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
328854001
TX
05
328854003
TX
05
328854004
TX
01
8DZ199
BCBS
TX
01
8ET191
BCBS
TX
Enumeration date
12/18/2006
Last updated
12/22/2014
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