Provider Demographics
NPI:1154307999
Name:CARROLL, BRANT F (MD)
Entity type:Individual
Prefix:
First Name:BRANT
Middle Name:F
Last Name:CARROLL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1101 MADISON ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1306
Mailing Address - Country:US
Mailing Address - Phone:206-215-2004
Mailing Address - Fax:206-215-2055
Practice Address - Street 1:1455 NW LEARY WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-5124
Practice Address - Country:US
Practice Address - Phone:206-784-3350
Practice Address - Fax:206-781-8693
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2014-04-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00036720207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0126806OtherLABOR & INDUSTRIES
CA3570OtherREGENCE HEALTHCARE
180036318OtherRAILROAD MEDICARE
WA8241861Medicaid
WA0126806OtherLABOR & INDUSTRIES
180036318OtherRAILROAD MEDICARE