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General NPI Number Information
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NPI Number | 1417319997
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Entity Type | Individual
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Provider Name | LUKE WALLACE CARSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/24/2016
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 1315 S ADAMS ST
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City | FORT WORTH
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State | TX
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Zip | 76104-4404
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Country | US
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Telephone | 833-484-6359
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Fax |
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Provider Business Mailing Address
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Address Line | 1830 E BROADWAY BLVD STE 124-95
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City | TUCSON
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State | AZ
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Zip | 85719-5966
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Country | US
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Telephone | 415-569-7161
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A150883
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 77909
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | T4501
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 042.0018472
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License Number State | VT
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