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NPI Code Detail

MEDICARE: MR. RAY LYNN CARLSON M.D.

MEDICARE: MR. RAY LYNN CARLSON M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianAK2778AK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114077468
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RAY LYNN CARLSON M.D.
Provider Business Mailing Address
First Line : PO BOX 240
Second Line :
City : KENAI
State : AK
Zip : 99611-0240
Country : US
Telephone Number : 907-283-9118
Fax Number : 907-283-5341
Provider Business Practice Location Address
First Line : 10543 KENAI SPUR HWY
Second Line :
City : KENAI
State : AK
Zip : 99611-7812
Country : US
Telephone Number : 907-283-9118
Fax Number : 907-283-5341
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2007
Last Update Date : 02/14/2014

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