Organization
CARROLL COUNTY MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY DOVER (CEO)
(660) 542-1695
Entity
Organization
Contact information
Practice address
1502 N JEFFERSON ST, ST SUITE A B, CARROLLTON, MO 64633-1948
(660) 542-3865
(660) 542-0336
Mailing address
1502 N JEFFERSON ST, SUITE A B, CARROLLTON, MO 64633-1948
(660) 542-3865
(660) 542-0336
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD106594
MO
207Q00000X
Family Medicine Physician
MD109202
MO
207R00000X
Internal Medicine Physician
MD106594
MO
2080A0000X
Pediatric Adolescent Medicine Physician
MD109202
MO
Other
Enumeration date
10/19/2010
Last updated
10/19/2010
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