WALLACE B CARROLL MD NPI 1003874124

Allergy & Immunology (Allergy) in Modesto, CA

About WALLACE CARROLL

Wallace Carroll is a provider in Modesto, CA. The NPI number assigned to this provider is 1003874124. The practitioner's primary taxonomy code is Allergy & Immunology (207KA0200X). The provider is registered as an individual and their NPI record was last updated 7 years ago.

NPI1003874124 Additional informationCallout TooltipNational Provider Indentifier (NPI)
The 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider Name WALLACE B CARROLL MD
Provider Location Address600 COFFEE RD MODESTO, CA 95355 Additional informationCallout TooltipProvider location address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Mailing Address600 COFFEE RD MODESTO, CA 95355 Additional informationCallout TooltipProvider mailing address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
GenderMale
NPI Entity TypeIndividual Additional informationCallout TooltipEntity type code
The code describing the type of health care provider that is being assigned an NPI.
Codes are:
1 = (Person): individual human being who furnishes health care;
2 = (Non-person): entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO).
Is Sole Proprietor?No
Is Organization Subpart?N/A Additional informationCallout TooltipWhat is a subpart?
Subparts are the components and separate physical locations of organization health care providers. Examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.
Enumeration Date05-01-2006 Additional informationCallout TooltipProvider enumeration date
The date the provider was assigned a unique identifier (assigned an NPI)
Last Update Date05-28-2010 Additional informationCallout TooltipLast update date
The date that a record was last updated or changed.

Business Address

WALLACE B CARROLL MD
600 COFFEE RD
MODESTO, CA
ZIP 95355
Phone: (209) 524-1211
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Mailing Address

WALLACE B CARROLL MD
600 COFFEE RD
MODESTO, CA
ZIP 95355
Phone: (209) 524-1211

Primary Taxonomy

Taxonomy Code207KA0200X Additional informationCallout TooltipPrimary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
ClassificationAllergy & Immunology
TypeAllopathic & Osteopathic Physicians
SpecializationAllergy
License No.A31444
License StateCA

Secondary Taxonomies


The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs the license data is associated to each taxonomy code.

No. Taxonomy Code Type Classification Specialization License No. State Primary
1208000000XAllopathic & Osteopathic PhysiciansPediatricsA31444CANo

Taxonomy Description: a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
00A314441MEDICARE PIN (08)CA
A26484MEDICARE UPIN (02)CA
00A314440MEDICAID (05)CA

Map Location


WALLACE B CARROLL MD address is 600 COFFEE RD MODESTO, CA 95355

Other Providers at the same location


The following 20 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1023074820 DAVID ALLEN BETZ MD
Individual
Anesthesiology600 COFFEE RD
MODESTO, CA 95355
(209) 524-1211
1104883644 DAVID H ADKINS MD
Individual
Internal Medicine (Hematology & Oncology)600 COFFEE RD
MODESTO, CA 95355
(209) 521-6097
1114983210 THOMAS G SALOPEK MD
Individual
Dermatology600 COFFEE RD
MODESTO, CA 95355
(209) 524-1211
1215907217 MATTHEW BRENT WARD M.D.
Individual
Radiology (Diagnostic Radiology)600 COFFEE RD
MODESTO, CA 95355
(209) 524-1211
1366408460 HIEN LE MD
Individual
Hospitalist600 COFFEE RD
MODESTO, CA 95355
(209) 524-1211
1376509554 MADHU SHOKEEN MD
Individual
Internal Medicine600 COFFEE RD
MODESTO, CA 95355
(209) 524-1211
1407812209 BRIGIDA ESTABILLO ANDAYA MD
Individual
Anesthesiology600 COFFEE RD
MODESTO, CA 95355
(209) 524-1211
1568428738 CHAI JIE CHANG MD
Individual
Anesthesiology600 COFFEE RD
MODESTO, CA 95355
(209) 524-1211
1619933850 MING ZHOU MD
Individual
Internal Medicine (Medical Oncology)600 COFFEE RD
MODESTO, CA 95355
(209) 524-1211
1629034434 RAMAN W KANON MD
Individual
Anesthesiology600 COFFEE RD
MODESTO, CA 95355
(209) 524-1211
1659337467 EUTIQUIO DESILVA IMPERIAL MD
Individual
Anesthesiology600 COFFEE RD
MODESTO, CA 95355
(209) 524-1211
1679539084 CHARLES FRED WILCOX MD
Individual
Obstetrics & Gynecology600 COFFEE RD
MODESTO, CA 95355
(209) 524-1211
1720044498 CENTI SANDY YOUNAN MD
Individual
Hospitalist600 COFFEE RD
MODESTO, CA 95355
(209) 524-1211
1730179136 GIACOMO RUOSI MD
Individual
Emergency Medicine600 COFFEE RD
MODESTO, CA 95355
(209) 524-1211
1740286640 VICTOR M ARROYO M.D.
Individual
Urology600 COFFEE RD
MODESTO, CA 95355
(209) 524-1211
1770548646 MAREK TADEUSZ SKOWRON M.D.
Individual
Internal Medicine600 COFFEE RD
MODESTO, CA 95355
(209) 524-1211
1841256948 NIRALI PATEL M.D.
Individual
Internal Medicine (Endocrinology, Diabetes & Metabolism)600 COFFEE RD
MODESTO, CA 95355
(209) 524-1211
1851357958 JAMES I THOMPSON DO
Individual
Anesthesiology600 COFFEE RD
MODESTO, CA 95355
(209) 521-6097
1891750121 KARL TOAN BUI DPM
Individual
Podiatrist (Foot & Ankle Surgery)600 COFFEE RD
MODESTO, CA 95355
(209) 524-1211
1922095132 MARIA GO MD
Individual
Internal Medicine600 COFFEE RD
MODESTO, CA 95355
(209) 524-1211