Basic Information
| Provider Information | |||||||||
| NPI: | 1104154665 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARROLL | ||||||||
| FirstName: | BELLA | ||||||||
| MiddleName: | STERLING | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 6201 N SANTA FE AVE STE 2010 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731187532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052725555 | ||||||||
| FaxNumber: | 4052725517 | ||||||||
| Practice Location | |||||||||
| Address1: | 6201 N SANTA FE AVE STE 2010 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731187532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052725555 | ||||||||
| FaxNumber: | 4052725517 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2009 | ||||||||
| LastUpdateDate: | 11/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 11/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | M0032 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 18611 | OK | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 18611 | 01 | OK | MEDICAL LICENSE | OTHER | M0032 | 01 | TX | TX MEDICAL BOARD | OTHER |