Provider Demographics
NPI:1528694767
Name:CARROLL, TIMOTHY FIELD
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:FIELD
Last Name:CARROLL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 DICKASON AVE APT 2616
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4987
Mailing Address - Country:US
Mailing Address - Phone:501-545-7355
Mailing Address - Fax:
Practice Address - Street 1:3435 DICKASON AVE APT 2616
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4987
Practice Address - Country:US
Practice Address - Phone:501-545-7355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program