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General NPI Number Information
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NPI Number | 1356768006
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Entity Type | Organization
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Legal Business Name | DAVID W CARLSON MD PA
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Dates
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Enumeration Date | 03/19/2014
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Last Update Date | 03/19/2014
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Provider Practice Location Address
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Address Line | 4402 BROADWAY BLVD SUITE 1
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City | GARLAND
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State | TX
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Zip | 75043-8263
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Country | US
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Telephone | 972-240-1789
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Fax |
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Provider Business Mailing Address
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Address Line | 4402 BROADWAY BLVD SUITE 1
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City | GARLAND
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State | TX
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Zip | 75043-8263
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Country | US
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Telephone | 972-240-1789
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | SYLVIA CARLSON
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Credential |
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Telephone | 972-240-1789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | HO233
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License Number State | TX
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