Healthcare Provider Details

I. General information

NPI: 1700058310
Provider Name (Legal Business Name): JOHN CLIFFORD CARLSON MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2008
Last Update Date: 03/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 TULANE AVE # SL-37
NEW ORLEANS LA
70112-2632
US

IV. Provider business mailing address

1430 TULANE AVE # SL-37
NEW ORLEANS LA
70112-2632
US

V. Phone/Fax

Practice location:
  • Phone: 504-988-5456
  • Fax: 504-988-1771
Mailing address:
  • Phone: 504-988-5456
  • Fax: 504-988-1771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD.200766
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD.200766
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: