Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | 67030 | MN |
NPI | 1659799351 |
---|---|
Provider Name | Brian Jeffrey Carroll |
First Address | Minneapolis, MN 55404-4387 |
Second Address | Minneapolis, MN 55404-4387 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2014 |
Last Update Date | 08/07/2020 |