Provider Demographics
NPI:1497766083
Name:CARLTON, ALISA (MD)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:
Last Name:CARLTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 E 3900 S
Mailing Address - Street 2:LABOR AND DELIVERY
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1348
Mailing Address - Country:US
Mailing Address - Phone:801-743-6540
Mailing Address - Fax:801-743-6573
Practice Address - Street 1:1250 E 3900 S
Practice Address - Street 2:LABOR AND DELIVERY
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1348
Practice Address - Country:US
Practice Address - Phone:801-743-6540
Practice Address - Fax:801-743-6573
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4886403-1205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005578909Medicare ID - Type Unspecified
UTH46704Medicare UPIN