Healthcare Provider Details

I. General information

NPI: 1760757066
Provider Name (Legal Business Name): DOUGLAS CARLSON DO, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4504 RIDGE RD
ALMA AR
72921-7488
US

IV. Provider business mailing address

4504 RIDGE RD
ALMA AR
72921-7488
US

V. Phone/Fax

Practice location:
  • Phone: 479-430-0626
  • Fax:
Mailing address:
  • Phone: 479-430-0626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberE4230
License Number StateAR

VIII. Authorized Official

Name: DOUGLAS EUGENE CARLSON
Title or Position: PRESIDENT
Credential: DO
Phone: 479-430-0626