Provider Demographics
NPI:1679797914
Name:CARLSON, LAURA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:MARIE
Last Name:CARLSON
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 1:12068 N TALL GRASS DR
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85755-8740
Mailing Address - Country:US
Mailing Address - Phone:646-425-9561
Mailing Address - Fax:
Practice Address - Street 1:39580 S LAGO DEL ORO PKWY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85739-1091
Practice Address - Country:US
Practice Address - Phone:520-624-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ345652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry