Individual
DR. PETER JOSEPH O'CARROLL III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1308E PALUXY RD STE 303, GRANBURY, TX 76048-5655
(817) 579-3948
(817) 579-3947
Mailing address
1308E PALUXY RD STE 303, GRANBURY, TX 76048-5655
(817) 579-3948
(817) 579-3947
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
N2220
TX
2084N0600X
Clinical Neurophysiology Physician
N2220
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
203901801
—
TX
01
—
P00736485
RR MCR
TX
Enumeration date
06/07/2007
Last updated
09/13/2020
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