Provider Demographics
NPI:1811995863
Name:CARSON, CHRIS ADAIR (MD)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:ADAIR
Last Name:CARSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:ADAIR
Other - Last Name:CARSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:10261 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-1051
Mailing Address - Country:US
Mailing Address - Phone:602-882-1015
Mailing Address - Fax:
Practice Address - Street 1:4129 E VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-6939
Practice Address - Country:US
Practice Address - Phone:602-797-8394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2005-03022084P0800X
AZ332312084P0800X
TXH79452084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ894932Medicaid
AZZ139484Medicare PIN
AZZ132233Medicare PIN