Provider Demographics
NPI:1215124151
Name:CARROLL, ELIZABETH (DO)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 E 32ND ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-2707
Mailing Address - Country:US
Mailing Address - Phone:512-544-5545
Mailing Address - Fax:
Practice Address - Street 1:1015 E 32ND ST
Practice Address - Street 2:SUITE 404
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-2707
Practice Address - Country:US
Practice Address - Phone:512-544-5545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA66265207R00000X
FLOS11071207R00000X
TXP40322084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine