Provider Demographics
NPI:1588763049
Name:CARROLL (JR.), ELDREDGE LINUS (MD)
Entity type:Individual
Prefix:DR
First Name:ELDREDGE
Middle Name:LINUS
Last Name:CARROLL (JR.)
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 959
Mailing Address - Street 2:123 RISER ST.
Mailing Address - City:COLUMBIA
Mailing Address - State:LA
Mailing Address - Zip Code:71418-0959
Mailing Address - Country:US
Mailing Address - Phone:318-649-2821
Mailing Address - Fax:318-649-5803
Practice Address - Street 1:123 RISER STREET
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:LA
Practice Address - Zip Code:71418-0959
Practice Address - Country:US
Practice Address - Phone:318-649-2821
Practice Address - Fax:318-649-5803
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10010146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1110388Medicaid
LA1110388Medicaid
LA5J389Medicare ID - Type Unspecified