Individual
BRYAN CARROLL
Active
Individual
BRYAN CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
0101252291
VA
207N00000X
Dermatology Physician
Primary
35.137019
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
-005
TRICARE/CHAMPUS
VA
01
—
10097097
OPTIMA HEALTH
VA
01
—
1609087121
COVENTRY HEALTH NETWORK
VA
05
—
1609087121
—
VA
01
—
473606
ANTHEM BC/BS
VA
05
—
5921028
—
NC
01
—
PAR
CIGNA
VA
Enumeration date
05/25/2007
Last updated
12/30/2020
Update your record
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