Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | BP10056740 | TX |
NPI | 1003270091 |
---|---|
Provider Name | Matthew Carroll |
First Address | Piscataway, NJ 08854-5066 |
Second Address | Houston, TX 77030-3411 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2016 |
Last Update Date | 06/04/2016 |