Provider Demographics
NPI:1174524987
Name:CARROLL, RAMON LEONARD JR (MD)
Entity type:Individual
Prefix:MR
First Name:RAMON
Middle Name:LEONARD
Last Name:CARROLL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 BOND ST
Mailing Address - Street 2:
Mailing Address - City:CLEWISTON
Mailing Address - State:FL
Mailing Address - Zip Code:33440-3812
Mailing Address - Country:US
Mailing Address - Phone:239-565-9437
Mailing Address - Fax:863-301-5430
Practice Address - Street 1:316 BOND ST
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-3812
Practice Address - Country:US
Practice Address - Phone:863-301-5450
Practice Address - Fax:863-301-5430
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97506208600000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAG739ZOtherMEDICARE PTAN
FL277596400Medicaid
FLAG739ZOtherMEDICARE PTAN
TND70146Medicare UPIN