Basic Information
| Provider Information | |||||||||
| NPI: | 1043214877 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARROLL | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | JOHN PHAM | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 N DOBSON RD | ||||||||
| Address2: | SUITE 15 | ||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852244412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802828336 | ||||||||
| FaxNumber: | 4802828365 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 N DOBSON RD | ||||||||
| Address2: | SUITE 15 | ||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802828336 | ||||||||
| FaxNumber: | 4802828365 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2005 | ||||||||
| LastUpdateDate: | 09/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 27603 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2Z5356 | 01 | AZ | HEALTHNET | OTHER | 7053073 | 01 | AZ | AETNA | OTHER | AZ0851511 | 01 | AZ | BCBSAZ | OTHER |