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General NPI Number Information
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NPI Number | 1508178799
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Entity Type | Individual
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Provider Name | JON BRANDON CARLSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/05/2010
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 621 S NEW BALLAS RD STE 3005B
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8266
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Country | US
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Telephone | 314-251-7070
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Fax |
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Provider Business Mailing Address
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Address Line | 621 S NEW BALLAS RD STE 3005B
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8266
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Country | US
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Telephone | 314-251-7070
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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 | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma Physician
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License Number | 48167
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 2024037003
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License Number State | MO
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