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Individual

MICHAEL DAVID CARROLL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2094
(208) 381-1791
Mailing address
PO BOX 1108, CORVALLIS, OR 97339-1108
(208) 381-2094
(208) 381-1791

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
125.056520
IL
2085R0202X
Diagnostic Radiology Physician
Primary
M-12823
ID

Other

Enumeration date
06/18/2009
Last updated
01/10/2018
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