Provider Demographics
NPI:1295783637
Name:CARLSON, ROBERT R (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:R
Last Name:CARLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BOB
Other - Middle Name:R
Other - Last Name:CARLSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:LOVELADY
Mailing Address - State:TX
Mailing Address - Zip Code:75851-0157
Mailing Address - Country:US
Mailing Address - Phone:970-580-6910
Mailing Address - Fax:
Practice Address - Street 1:1320 N UNIVERSITY DR STE A
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4270
Practice Address - Country:US
Practice Address - Phone:936-568-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5647208600000X
SD10187208600000X
IA33347208600000X
TXK3890208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA15690OtherWELLMARK BC/BS
020045344OtherRAILROAD MEDICARE
149900OtherIOWA HEALTH SOLUTIONS
18978OtherMIDLANDS CHOICE
IA 0184OtherJOHN DEERE HEALTH
056885OtherHEALTH ALLIANCE
IA0205799Medicaid
020045344OtherRAILROAD MEDICARE
G56106Medicare UPIN
C810525Medicare PIN