Healthcare Provider Details

I. General information

NPI: 1558344630
Provider Name (Legal Business Name): WILLIAM E CARLSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 03/31/2020
Certification Date: 03/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 SE MONTEREY RD SUITE 400
STUART FL
34994
US

IV. Provider business mailing address

1050 SE MONTEREY RD SUITE 400
STUART FL
34994
US

V. Phone/Fax

Practice location:
  • Phone: 772-288-2400
  • Fax:
Mailing address:
  • Phone: 772-288-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberME67339
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME67339
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: