MEDICARE: DR. CHESTER L. CARLSON D.O.

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
1	207P00000X	Emergency Medicine Physician	E-5307	AR
2	208D00000X	General Practice Physician	E5307	AR
3	208D00000X	General Practice Physician	E-5307	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5H348	OTHER	AR	ARKANSAS BLUE CROSS

General Provider Information

NPI Number	:	1164544045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHESTER L. CARLSON D.O.

Provider Business Mailing Address
First Line	:	5212 VILLAGE PKWY
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-8104
Country	:	US
Telephone Number	:	479-657-6888
Fax Number	:

Provider Business Practice Location Address
First Line	:	5212 VILLAGE PKWY
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-8104
Country	:	US
Telephone Number	:	479-657-6888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	04/02/2015

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