Provider Demographics
NPI:1184059917
Name:CARSON, MARY GRACE (DVM)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:GRACE
Last Name:CARSON
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16575 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80023-8971
Mailing Address - Country:US
Mailing Address - Phone:720-977-7124
Mailing Address - Fax:720-977-7147
Practice Address - Street 1:16575 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80023-8971
Practice Address - Country:US
Practice Address - Phone:720-977-7124
Practice Address - Fax:720-977-7147
Is Sole Proprietor?:No
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7940174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian