Provider Demographics
NPI:1124247341
Name:CARROLL, MATTHEW BERNARD (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BERNARD
Last Name:CARROLL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2101 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-5340
Mailing Address - Country:US
Mailing Address - Phone:228-497-7576
Mailing Address - Fax:228-497-8869
Practice Address - Street 1:3101 DENNY AVE STE 240
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-5307
Practice Address - Country:US
Practice Address - Phone:228-696-9995
Practice Address - Fax:228-696-9906
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2022-05-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS23890207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06688263Medicaid