Individual
DR. RONALD EUGENE CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
823 CENTER AVE, PAYETTE, ID 83661-2535
(208) 642-3396
(208) 642-9060
Mailing address
823 CENTER AVE, P.O. BOX 175, PAYETTE, ID 83661-2535
(208) 642-3396
(208) 642-9060
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M-4116
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010005775
REGENCE BLUE SHIELD
—
05
—
003636500
—
ID
05
—
231902
—
OR
01
—
73437
BLUE CROSS
—
01
—
820525763
COMMERCIAL
—
01
—
D80174720
MEDICARE- RAILROAD
—
01
—
R108734
MEDICARE-NORIDIAN
—
Enumeration date
01/30/2007
Last updated
06/14/2022
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