Provider Demographics
NPI:1295784932
Name:CARLSON, THEODORE JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:JOHN
Last Name:CARLSON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:8210 WALNUT HILL LANE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231
Mailing Address - Country:US
Mailing Address - Phone:214-363-0000
Mailing Address - Fax:214-363-0713
Practice Address - Street 1:8210 WALNUT HILL LANE
Practice Address - Street 2:SUITE 208
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231
Practice Address - Country:US
Practice Address - Phone:214-363-0000
Practice Address - Fax:214-363-0713
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2012-11-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXG48932080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology