Provider Demographics
NPI:1487632683
Name:CARLSON, ROBERT E (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:CARLSON
Suffix:
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 1:122 3RD ST NE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-4013
Mailing Address - Country:US
Mailing Address - Phone:253-833-7750
Mailing Address - Fax:253-887-9804
Practice Address - Street 1:122 3RD ST NE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4013
Practice Address - Country:US
Practice Address - Phone:253-833-7750
Practice Address - Fax:253-833-7469
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00036284174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8227696OtherDSHS
WACA3785OtherREGENCE
WA123239OtherLABOR & INDUSTRIES
WA8227696OtherDSHS
WAG54967Medicare UPIN