MEDICARE: DR. ROBERT CARLSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	A111109	CA

General Provider Information

NPI Number	:	1518289438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT CARLSON M.D.

Provider Business Mailing Address
First Line	:	10813 PORTOBELO DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92124-1121
Country	:	US
Telephone Number	:	858-877-3701
Fax Number	:

Provider Business Practice Location Address
First Line	:	10813 PORTOBELO DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92124-1121
Country	:	US
Telephone Number	:	858-877-3701
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2010
Last Update Date	:	09/27/2012

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