Provider Demographics
NPI:1467562819
Name:CARLSSON, LAWRENCE ALGOT JR (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:ALGOT
Last Name:CARLSSON
Suffix:JR
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 1:2302 8TH AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PLATTSMOUTH
Mailing Address - State:NE
Mailing Address - Zip Code:68048-2365
Mailing Address - Country:US
Mailing Address - Phone:402-296-4453
Mailing Address - Fax:402-296-5154
Practice Address - Street 1:2302 8TH AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:PLATTSMOUTH
Practice Address - State:NE
Practice Address - Zip Code:68048-2365
Practice Address - Country:US
Practice Address - Phone:402-296-4453
Practice Address - Fax:402-296-5154
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13639207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47071211212Medicaid
095100Medicare ID - Type Unspecified
NE47071211212Medicaid
NE080057261Medicare PIN