Provider Demographics
NPI:1093846016
Name:CARLSON, DENNIS JASON (PA-C)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:JASON
Last Name:CARLSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 W PARKER RD STE 124
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8100
Mailing Address - Country:US
Mailing Address - Phone:972-981-7195
Mailing Address - Fax:972-981-7194
Practice Address - Street 1:6300 W PARKER RD STE 124
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8100
Practice Address - Country:US
Practice Address - Phone:972-981-7195
Practice Address - Fax:972-981-7194
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04977363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD561596ZDDBMedicare PIN
MD561782YWV2Medicare PIN
MD561592YVZMedicare PIN