Provider Demographics
NPI:1295989630
Name:CARROLL, DORIAN J (PA-C)
Entity type:Individual
Prefix:MR
First Name:DORIAN
Middle Name:J
Last Name:CARROLL
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:6095 FASHION BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-7377
Mailing Address - Country:US
Mailing Address - Phone:801-263-8700
Mailing Address - Fax:801-263-8693
Practice Address - Street 1:6095 FASHION BLVD STE 100
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7377
Practice Address - Country:US
Practice Address - Phone:801-263-8700
Practice Address - Fax:801-263-8693
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2023-01-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT5182589-1206207K00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology