Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | I0769 | TX |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 49410 | WI |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | L0769 | TX |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | MD45200 | TN |
NPI | 1235162116 |
---|---|
Provider Name | Mary Anne Carroll |
First Address | Lubbock, TX 79430-8340 |
Second Address | Lubbock, TX 79430-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 02/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H27683 | (02) |