Provider Demographics
NPI:1073538468
Name:CARLSON, DAVID L (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:CARLSON
Suffix:
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 1:401 W. 2ND ST.
Mailing Address - Street 2:#235D/ MS 353
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503
Mailing Address - Country:US
Mailing Address - Phone:775-682-8175
Mailing Address - Fax:775-327-2006
Practice Address - Street 1:5190 NEIL RD
Practice Address - Street 2:215
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-6599
Practice Address - Country:US
Practice Address - Phone:775-784-4917
Practice Address - Fax:775-784-1428
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ND64462084P0800X
MN412762084P0800X
NV153502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND18506Medicaid
ND64G63CAOtherMNBS #
ND117309OtherUCARE #
ND1542639OtherMEDICA #
ND16003OtherNDBS #
ND355326400Medicaid
NDND200168OtherLHS #
ND20315OtherAMERICA'S PPO #
NDDA9011026962OtherPREFERRED ONE #
ND58D31CAOtherMNBS #
NDHP21429OtherHEALTHPARTNERS #
ND18506Medicaid
ND64G63CAOtherMNBS #
NDF90315Medicare UPIN