Provider Demographics
NPI:1538133095
Name:CARLSON, JEFFREY JERAL (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:JERAL
Last Name:CARLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6431 FANNIN STREET
Mailing Address - Street 2:MSB 2.130B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:713-500-7700
Mailing Address - Fax:713-500-7639
Practice Address - Street 1:6431 FANNIN STREET
Practice Address - Street 2:MSB 2.130B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-500-7700
Practice Address - Fax:713-500-7639
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM65572085R0202X
OH35.0942822085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology