Provider Demographics
NPI:1760576136
Name:CARLSON, ERIK E (MD)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:E
Last Name:CARLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 92110
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87199-2110
Mailing Address - Country:US
Mailing Address - Phone:505-301-5155
Mailing Address - Fax:
Practice Address - Street 1:PMG RHEUMATOLOGY
Practice Address - Street 2:8300 CONSTITUTION AVE NE
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110
Practice Address - Country:US
Practice Address - Phone:505-291-2222
Practice Address - Fax:505-291-2440
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM69-114207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM4929Medicaid
D43069Medicare UPIN
NM4929Medicaid