Provider Demographics
NPI:1790774776
Name:CARLSON, DAWN E (MD)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:E
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 1:126 STANWELL ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-7993
Mailing Address - Country:US
Mailing Address - Phone:719-576-0515
Mailing Address - Fax:
Practice Address - Street 1:445 E CHEYENNE MOUNTAIN BLVD STE C
Practice Address - Street 2:PMB 406
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4570
Practice Address - Country:US
Practice Address - Phone:877-978-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0006172207PE0004X
MO2005021691207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207294406Medicaid
MO938373209Medicare PIN
MO938384748Medicare PIN
MO938374740Medicare PIN
MO938373212Medicare PIN
ILOTH000Medicare UPIN
MO938375198Medicare PIN
H39877Medicare UPIN
MO938375005Medicare PIN