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General NPI Number Information
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NPI Number | 1023008398
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Entity Type | Individual
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Provider Name | MARK D CARLSON MD
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Gender | Male
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Dates
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Enumeration Date | 10/26/2005
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Last Update Date | 04/16/2019
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Provider Practice Location Address
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Address Line | 1905 S LAKELINE BLVD STE 4
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City | CEDAR PARK
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State | TX
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Zip | 78613
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Country | US
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Telephone | 512-553-1921
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Fax |
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Provider Business Mailing Address
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Address Line | 1905 S LAKELINE BLVD STE 4
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City | CEDAR PARK
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State | TX
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Zip | 78613-4660
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Country | US
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Telephone | 512-553-1921
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | Q2258
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 21230
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | Q2258
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | Q2258
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License Number State | TX
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