Healthcare Provider Details

I. General information

NPI: 1811995863
Provider Name (Legal Business Name): CHRIS ADAIR CARSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CHRIS ADAIR CARSON MD

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 11/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4129 E VAN BUREN ST
PHOENIX AZ
85008-6939
US

IV. Provider business mailing address

10261 N CENTRAL AVE
PHOENIX AZ
85020-1051
US

V. Phone/Fax

Practice location:
  • Phone: 602-797-8394
  • Fax:
Mailing address:
  • Phone: 602-882-1015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD2005-0302
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number33231
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberH7945
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: