WALLACE B CARROLL MD NPI 1003874124

NPI Information

NPI: 1003874124
Provider Name: WALLACE B CARROLL, MD
Classification: Allergy & Immunology - 207KA0200X
Entity Type: Individual

Specialization: Allergy

Address:
600 COFFEE RD
MODESTO, CA
ZIP 95355
Phone: (209) 524-1211
Get Directions

Wallace B Carroll, MD is an allergy allergy immunology in Modesto, CA. Wallace B Carroll, MD NPI is 1003874124. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

600 COFFEE RD
MODESTO, CA
ZIP 95355-201
Phone: (209) 524-1211

The enumeration date for this NPI number is 5/1/2006 and was last updated on 5/28/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208000000X	Pediatrics		A31444	CALIFORNIA	No
2	207KA0200X	Allergy & Immunology	Allergy	A31444	CALIFORNIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	00A314441	MEDICARE PIN	CALIFORNIA
2	A26484	MEDICARE UPIN	CALIFORNIA
3	00A314440	MEDICAID	CALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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