Individual
CORY DOUGLAS CARROLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1032 LUKE ST 2, FORT COLLINS, CO 80524-4037
(970) 221-5858
(970) 484-7191
Mailing address
1032 LUKE ST 2, FORT COLLINS, CO 80524-4037
(970) 221-5858
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
30253
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01302538
—
CO
Enumeration date
08/12/2006
Last updated
08/04/2015
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