Provider Demographics
NPI:1043227283
Name:ANDERSON, CARLA J (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:J
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:150 E HARMON AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-4533
Mailing Address - Country:US
Mailing Address - Phone:701-796-1116
Mailing Address - Fax:702-369-4117
Practice Address - Street 1:150 EAST HARMON AVENUE
Practice Address - Street 2:HARMON MEDICAL CLINIC
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109
Practice Address - Country:US
Practice Address - Phone:702-796-1116
Practice Address - Fax:702-369-4117
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11967207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARE02921Medicare UPIN
AR50602Medicare ID - Type Unspecified