Provider Demographics
NPI:1922219500
Name:CARLSON, JONATHAN D (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:D
Last Name:CARLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:105 W 8TH AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2302
Mailing Address - Country:US
Mailing Address - Phone:509-624-9112
Mailing Address - Fax:509-624-1087
Practice Address - Street 1:105 W 8TH AVE
Practice Address - Street 2:STE 200
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2302
Practice Address - Country:US
Practice Address - Phone:509-624-9112
Practice Address - Fax:509-624-1087
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2021-05-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00049415207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery