Provider Demographics
NPI:1952306243
Name:CARLSON, DOUGLAS J (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:J
Last Name:CARLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1719 TOWER DR W
Mailing Address - Street 2:STE 100
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-7512
Mailing Address - Country:US
Mailing Address - Phone:651-275-3000
Mailing Address - Fax:651-275-3027
Practice Address - Street 1:2950 CURVE CREST BLVD W
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-5085
Practice Address - Country:US
Practice Address - Phone:651-275-3000
Practice Address - Fax:651-275-3027
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN21564207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI180046280OtherRAILROAD MEDICARE
MN241590900Medicaid
MN180008787OtherRAILROAD MEDICARE
WI180046280OtherRAILROAD MEDICARE
WI000248055Medicare PIN
MN180008787OtherRAILROAD MEDICARE