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General NPI Number Information
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NPI Number | 1295783637
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Entity Type | Individual
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Provider Name | ROBERT R CARLSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 1320 N UNIVERSITY DR STE A
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City | NACOGDOCHES
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State | TX
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Zip | 75961-4270
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Country | US
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Telephone | 936-568-9600
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 157
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City | LOVELADY
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State | TX
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Zip | 75851-0157
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Country | US
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Telephone | 970-580-6910
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 5647
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 10187
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License Number State | SD
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 33347
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License Number State | IA
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Taxonomy #4
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | K3890
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License Number State | TX
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