Provider Demographics
NPI:1013177955
Name:CARLSON, MARK S (DO)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:S
Last Name:CARLSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2720 STONE PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-3734
Mailing Address - Country:US
Mailing Address - Phone:712-279-3209
Mailing Address - Fax:712-233-8095
Practice Address - Street 1:2720 STONE PARK BLVD
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-3734
Practice Address - Country:US
Practice Address - Phone:712-279-3209
Practice Address - Fax:712-233-8095
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2016-11-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA4286207L00000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology