Individual
DR. BRIAN DAVID O'CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
911 OAK PARK BLVD, STE 106, PISMO BEACH, CA 93449-3406
(805) 481-9100
(805) 481-9199
Mailing address
911 OAK PARK BLVD, STE 106, PISMO BEACH, CA 93449-3406
(805) 481-9100
(805) 481-9199
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
E4758
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000E47580
BLUE SHIELD
CA
05
—
016004922
—
IL
01
—
E4758
CA MED LICENSE
CA
Enumeration date
08/31/2005
Last updated
03/15/2012
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