Provider Demographics
NPI:1477753069
Name:CARLSON, ANNAMAY D (DO)
Entity Type:Individual
Prefix:DR
First Name:ANNAMAY
Middle Name:D
Last Name:CARLSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ANNAMAY
Other - Middle Name:D
Other - Last Name:CARLSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:4419 S CRYSLER AVE
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-5948
Mailing Address - Country:US
Mailing Address - Phone:816-356-0400
Mailing Address - Fax:816-356-0477
Practice Address - Street 1:4419 S CRYSLER AVE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-5948
Practice Address - Country:US
Practice Address - Phone:816-356-0400
Practice Address - Fax:816-356-0477
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7A22208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOE47008Medicare UPIN