Provider Demographics
NPI:1639277866
Name:KARLSSON, MARTEN E (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MARTEN
Middle Name:E
Last Name:KARLSSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 E NELSON ST
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:TX
Mailing Address - Zip Code:76230-3806
Mailing Address - Country:US
Mailing Address - Phone:940-872-5447
Mailing Address - Fax:
Practice Address - Street 1:705 E GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:TX
Practice Address - Zip Code:76230-3135
Practice Address - Country:US
Practice Address - Phone:940-872-1121
Practice Address - Fax:940-872-9407
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01777363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX189114502Medicaid
TXP01064957OtherMEDICARE RAILROAD