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NPI Code Detail

MEDICARE: DR. MATTHEW CARLSON MD

MEDICARE: DR. MATTHEW CARLSON MD
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
1207R00000XInternal Medicine Physician20383MS
2208M00000XHospitalist Physician20383MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
120383OTHERMSMISSISSIPPI STATE LICENSE

General Provider Information

NPI Number : 1609865682
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MATTHEW CARLSON MD
Provider Business Mailing Address
First Line : PO BOX 1810
Second Line :
City : GULFPORT
State : MS
Zip : 39502
Country : US
Telephone Number : 228-575-1194
Fax Number : 228-575-2917
Provider Business Practice Location Address
First Line : 4500 13TH ST
Second Line :
City : GULFPORT
State : MS
Zip : 39501-2515
Country : US
Telephone Number : 228-376-0577
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2005
Last Update Date : 09/14/2023

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Directions to “ DR. MATTHEW CARLSON MD” Practice Location

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