Provider Demographics
NPI:1144291519
Name:MCCARROLL, KARIS M (MD PA)
Entity type:Individual
Prefix:
First Name:KARIS
Middle Name:M
Last Name:MCCARROLL
Suffix:
Gender:F
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16110 VIA SHAVANO
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-2380
Mailing Address - Country:US
Mailing Address - Phone:210-615-7171
Mailing Address - Fax:210-615-6793
Practice Address - Street 1:16110 VIA SHAVANO
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2380
Practice Address - Country:US
Practice Address - Phone:210-615-7171
Practice Address - Fax:210-615-6793
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5032207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1144291519OtherNPI
TX097574002Medicaid
TX240007915OtherRAILROAD MEDICARE NUMBER
TXG5032OtherTEXAS LICENSE
TX00B79COtherBLUE CROSS BLUE SHIELD
TXG5032OtherTEXAS LICENSE
TX00B79CMedicare PIN
TXC19033Medicare UPIN
TX1144291519OtherNPI