Provider Demographics
NPI:1902829419
Name:CARLSON, LOREN SCOTT (DO)
Entity Type:Individual
Prefix:DR
First Name:LOREN
Middle Name:SCOTT
Last Name:CARLSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2415 UNIVERSITY PKWY
Mailing Address - Street 2:SUITE 111
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-2809
Mailing Address - Country:US
Mailing Address - Phone:941-351-2020
Mailing Address - Fax:941-360-1362
Practice Address - Street 1:2415 UNIVERSITY PKWY
Practice Address - Street 2:SUITE 111
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2809
Practice Address - Country:US
Practice Address - Phone:941-351-2020
Practice Address - Fax:941-360-1362
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8011207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258501400Medicaid
FLA75414Medicare UPIN