Provider Demographics
NPI:1649380478
Name:CARLSON, TIM PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:TIM
Middle Name:PAUL
Last Name:CARLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1615 PASADENA AVE S
Mailing Address - Street 2:SUITE 430
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:FL
Mailing Address - Zip Code:33707-4516
Mailing Address - Country:US
Mailing Address - Phone:727-397-0606
Mailing Address - Fax:727-397-6161
Practice Address - Street 1:1615 PASADENA AVE S
Practice Address - Street 2:SUITE 430
Practice Address - City:SOUTH PASADENA
Practice Address - State:FL
Practice Address - Zip Code:33707-4516
Practice Address - Country:US
Practice Address - Phone:727-397-0606
Practice Address - Fax:727-397-6161
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME89730207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE3276VMedicare ID - Type Unspecified
S93003Medicare UPIN
FL271018800Medicare ID - Type Unspecified