Provider Demographics
NPI:1326227265
Name:CARLSON, LUANNE MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:LUANNE
Middle Name:MARIE
Last Name:CARLSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:555 E TACHEVAH DR
Mailing Address - Street 2:2E-204
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-5750
Mailing Address - Country:US
Mailing Address - Phone:760-561-7336
Mailing Address - Fax:760-257-5553
Practice Address - Street 1:555 E TACHEVAH DR
Practice Address - Street 2:2E-204
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-5750
Practice Address - Country:US
Practice Address - Phone:760-561-7336
Practice Address - Fax:760-257-5553
Is Sole Proprietor?:No
Enumeration Date:2007-10-28
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A10178207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
20A10178Medicare UPIN