Healthcare Provider Details

I. General information

NPI: 1114185493
Provider Name (Legal Business Name): DAVID W CARLSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 05/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 S 11TH AVE SUITE A
YAKIMA WA
98902-3212
US

IV. Provider business mailing address

501 S 5TH AVE
YAKIMA WA
98902-3550
US

V. Phone/Fax

Practice location:
  • Phone: 509-575-0114
  • Fax: 509-575-0808
Mailing address:
  • Phone: 509-494-6700
  • Fax: 509-573-6275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOT-011450
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOP60093316
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: