MEDICARE: BONITA CARSON MD

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	2080N0001X	Neonatal-Perinatal Medicine Physician	18487	CO

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

General Provider Information

NPI Number	:	1770668402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONITA CARSON MD

Provider Business Mailing Address
First Line	:	13611 E COLFAX AVE
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80045-5701
Country	:	US
Telephone Number	:	303-493-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	4191 S COLORADO BLVD
Second Line	:
City	:	ENGLEWOOD
State	:	CO
Zip	:	80113-5039
Country	:	US
Telephone Number	:	303-493-7000
Fax Number	:

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	04/07/2009

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