Organization
BRIAN O'CARROLL, D.P.M., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN DAVID O'CARROLL DPM (OWNER)
(805) 481-9100
Entity
Organization
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
01
—
E4758
CA MED LICENSE
CA
Enumeration date
12/10/2010
Last updated
03/15/2012
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