Carroll, Wallace B

Carroll, Wallace B is an individual health care provider with primary practice located at 600 Coffee Rd , Modesto CA 95355-4201. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Allergy, Allopathic & Osteopathic Physicians / Pediatrics. Allopathic & Osteopathic Physicians / Allergy is his primary health care specialty. Carroll, Wallace B can be contacted via phone (209) 524-1211.

Contact Information

Primary practice address
600 Coffee Rd Modesto CA 95355-4201
Phone: (209) 524-1211
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Allergy 207KA0200X A31444 California
Allopathic & Osteopathic Physicians / Pediatrics 208000000X A31444 California

Profile Details

NPI number 1003874124
LBN Legal business name Carroll, Wallace B
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 1st, 2006
Last updated May 28th, 2010 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1003874124 NPPES
California MEDICAID 00A314440

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