Individual
DR. JERRY SCOTT CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
734 N 3RD ST, SUITE 115, LEESBURG, FL 34748-5285
(352) 365-2583
(352) 728-6749
Mailing address
734 N 3RD ST, SUITE 115, LEESBURG, FL 34748-5285
(352) 365-2583
(352) 728-6749
Taxonomy
Speciality
Code
Description
License number
State
207RM1200X
Magnetic Resonance Imaging (MRI) Internal Medicine Physician
Primary
ME109665
FL
2085R0202X
Diagnostic Radiology Physician
ME109665
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03876000
—
FL
01
—
P00986156
RR MEDICARE RACF
FL
01
—
P00986170
RR MEDICARE LMIV
FL
Enumeration date
01/21/2008
Last updated
08/26/2020
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