Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 8160 | NV |
N | 207RG0100X | Gastroenterologist | MD153344 | OR |
NPI | 1023119138 |
---|---|
Provider Name | Clifford Carrol |
First Address | Las Vegas, NV 89133-4795 |
Second Address | Las Vegas, NV 89128-0465 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1023119138 | (05) | NV |