Provider Demographics
NPI:1689622920
Name:CARLISLE, ROBERT LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LOUIS
Last Name:CARLISLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9000
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-9000
Mailing Address - Country:US
Mailing Address - Phone:719-553-0111
Mailing Address - Fax:719-553-0117
Practice Address - Street 1:3937 IVYWOOD LN
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-2551
Practice Address - Country:US
Practice Address - Phone:719-553-0111
Practice Address - Fax:719-553-0117
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO29798207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01297985Medicaid
COA09532Medicare UPIN
COC15761Medicare ID - Type Unspecified