MEDICARE: DAVID W CARLSON MD PA

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	261QP2300X	Primary Care Clinic/Center	HO233	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1700961406	OTHER	TX	NPI
2	C14201	OTHER	TX	UPIN

General Provider Information

NPI Number	:	1356768006
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID W CARLSON MD PA

Provider Business Mailing Address
First Line	:	4402 BROADWAY BLVD
Second Line	:	SUITE 1
City	:	GARLAND
State	:	TX
Zip	:	75043-8263
Country	:	US
Telephone Number	:	972-240-1789
Fax Number	:

Provider Business Practice Location Address
First Line	:	4402 BROADWAY BLVD
Second Line	:	SUITE 1
City	:	GARLAND
State	:	TX
Zip	:	75043-8263
Country	:	US
Telephone Number	:	972-240-1789
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	SYLVIA CARLSON
Credential	:
Telephone Number	:	972-240-1789

Provider Enumeration Date	:	03/19/2014
Last Update Date	:	03/19/2014

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