Provider Demographics
NPI:1033285945
Name:CARLSON, DAVID W (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:CARLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 W AGENCY RD
Mailing Address - Street 2:
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1645
Mailing Address - Country:US
Mailing Address - Phone:319-754-4242
Mailing Address - Fax:319-754-4079
Practice Address - Street 1:1201 W AGENCY RD
Practice Address - Street 2:
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1645
Practice Address - Country:US
Practice Address - Phone:319-754-4242
Practice Address - Fax:319-754-4079
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA27458207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2064808Medicaid
IAE48738Medicare UPIN
IA04318Medicare PIN