Provider Demographics
NPI:1770627077
Name:CARLTON, GREGORY T
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:T
Last Name:CARLTON
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:GREGORY
Other - Middle Name:T
Other - Last Name:CARLTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:760 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:RUSH CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55069-9063
Mailing Address - Country:US
Mailing Address - Phone:651-982-7966
Mailing Address - Fax:320-358-4665
Practice Address - Street 1:2450 RIVERSIDE AVE
Practice Address - Street 2:FCO-4
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1450
Practice Address - Country:US
Practice Address - Phone:612-672-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN30076207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MND79995Medicare UPIN