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NPI Code Detail

MEDICARE: ALYSSA SNOW CARLSON M.D.

MEDICARE:   ALYSSA SNOW 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 PhysicianDR.0050026CO

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 : 1205066388
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALYSSA SNOW CARLSON M.D.
Provider Business Mailing Address
First Line : PO BOX 9049
Second Line :
City : BOULDER
State : CO
Zip : 80301-9049
Country : US
Telephone Number : 303-415-8900
Fax Number : 303-443-6476
Provider Business Practice Location Address
First Line : 1645 BROADWAY
Second Line :
City : BOULDER
State : CO
Zip : 80302-6218
Country : US
Telephone Number : 303-415-8900
Fax Number : 303-443-6476
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2009
Last Update Date : 10/20/2023

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