Provider Demographics
NPI:1932514627
Name:CARLSON, COLBY (DPM)
Entity Type:Individual
Prefix:
First Name:COLBY
Middle Name:
Last Name:CARLSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 CHAMBERS ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-3745
Mailing Address - Country:US
Mailing Address - Phone:541-342-3373
Mailing Address - Fax:541-342-3374
Practice Address - Street 1:1060 CHAMBERS ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3745
Practice Address - Country:US
Practice Address - Phone:541-342-3373
Practice Address - Fax:541-342-3374
Is Sole Proprietor?:No
Enumeration Date:2014-06-22
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPR377390200000X
ORDP182931213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program