Provider Demographics
NPI:1467516120
Name:ROBERT CARLSON MD FACS PL
Entity Type:Organization
Organization Name:ROBERT CARLSON MD FACS PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-955-1815
Mailing Address - Street 1:1901 FLOYD ST STE 302
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2932
Mailing Address - Country:US
Mailing Address - Phone:941-955-1815
Mailing Address - Fax:941-955-1815
Practice Address - Street 1:1901 FLOYD ST
Practice Address - Street 2:SUITE 302
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2932
Practice Address - Country:US
Practice Address - Phone:941-955-1815
Practice Address - Fax:941-955-1815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51783174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty