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Individual

DR. CARROLL PAUL SHIVERS JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1000 BLYTHE BLVD, CHARLOTTE, NC 28203-5812
(704) 355-2000
Mailing address
927 EAST BLVD, CHARLOTTE, NC 28203-5203
(704) 377-5772

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
0101054441
VA
207L00000X
Anesthesiology Physician
Primary
28622
NC
207L00000X
Anesthesiology Physician
28622
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
010090547
VA
01
1162G
BCBSNC
NC
01
28622
MEDICAL LICENSE
SC
05
286229
SC
05
891162G
NC
01
P00893113
RAILROAD-MEDICARE
SC
01
P00906978
RAILROAD-MEDICARE
NC
Enumeration date
01/05/2006
Last updated
01/30/2015
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