Healthcare Provider Details

I. General information

NPI: 1548362676
Provider Name (Legal Business Name): CARLSON EAR NOSE AND THROAT ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 E TANGERINE RD
ORO VALLEY AZ
85755-6225
US

IV. Provider business mailing address

1521 E TANGERINE RD
ORO VALLEY AZ
85755-6225
US

V. Phone/Fax

Practice location:
  • Phone: 520-797-8789
  • Fax: 520-797-8787
Mailing address:
  • Phone: 520-797-8789
  • Fax: 520-797-8787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES R CARLSON
Title or Position: DIRECTOR
Credential: M.D.
Phone: 520-797-8789