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1508842584

NPI Code Detail

MEDICARE: JEFFREY REED CARLSON II DO

MEDICARE: JEFFREY REED CARLSON II DO

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	207RP1001X	Pulmonary Disease Physician	44656	MN
2	2084P0800X	Psychiatry Physician	44656	MN
3	2084P0804X	Child & Adolescent Psychiatry Physician	44656	MN
4	2084S0012X	Sleep Medicine (Psychiatry & Neurology) Physician	44656	MN
5	2084P0800X	Psychiatry Physician	DO166997	OR

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508842584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY REED CARLSON II DO

Provider Business Mailing Address
First Line	:	PO BOX 3158
Second Line	:	ST. CLOUD HOSPITAL
City	:	PORTLAND
State	:	OR
Zip	:	97208-3158
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 DIVISION ST
Second Line	:	1ST FLOOR
City	:	OREGON CITY
State	:	OR
Zip	:	97045-1527
Country	:	US
Telephone Number	:	503-722-3705
Fax Number	:

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

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	02/20/2017

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Directions to “ JEFFREY REED CARLSON II DO” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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