Individual
MR. JEFFREY D.T. CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
307 S 13TH ST STE 300, MOUNT VERNON, WA 98274-4100
(360) 336-9757
(360) 814-5237
Mailing address
1400 E. KINCAID STREET, ATTN: CREDENTIALING, MOUNT VERNON, WA 98274-4127
(360) 428-2500
(360) 428-6485
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA60794256
WA
363AM0700X
Medical Physician Assistant
Primary
PA60794256
WA
Other
Enumeration date
04/23/2017
Last updated
03/17/2018
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