Individual
MR. JEFFREY W CARROLL
Active
Individual
MR. JEFFREY W CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA C
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
PA1217
TN
363AS0400X
Surgical Physician Assistant
Primary
PA398
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009978285
—
AL
01
—
090219
UNITED HEALTHCARE
AL
01
—
51000081
BCBS
AL
01
—
7190662
AETNA
AL
Enumeration date
03/18/2006
Last updated
11/11/2013
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