Individual
JOHN SHALLEY CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
609 FORD ST, MAUMEE, OH 43537-1947
(419) 893-5539
(419) 893-6853
Mailing address
609 FORD ST, MAUMEE, OH 43537-1947
(419) 893-5539
(419) 893-6853
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
36 001951
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000135410
ANTHEM
—
01
—
00059
PARAMOUNT
OH
05
—
0447047
—
OH
Enumeration date
07/20/2005
Last updated
02/12/2010
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