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NPI Code Detail

MEDICARE: CARSON MEDICAL GROUP PROFESSIONAL CORPORATION

MEDICARE: CARSON MEDICAL GROUP PROFESSIONAL CORPORATION
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
1207V00000XObstetrics & Gynecology Physician
2207Y00000XOtolaryngology Physician
3208000000XPediatrics Physician
4207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1780694620
Entity Type Code : Organization
Provider Name (Legal Business Name) : CARSON MEDICAL GROUP PROFESSIONAL CORPORATION
Provider Business Mailing Address
First Line : 1946 OLD HOT SPRINGS RD
Second Line :
City : CARSON CITY
State : NV
Zip : 89706-0674
Country : US
Telephone Number : 775-283-5050
Fax Number : 775-882-2382
Provider Business Practice Location Address
First Line : 1946 OLD HOT SPRINGS RD
Second Line :
City : CARSON CITY
State : NV
Zip : 89706-0674
Country : US
Telephone Number : 775-283-5050
Fax Number :
Authorized Official
Title or Position : CREDENTIALING SPECIALIST
Name : LAURIE CAMPER
Credential :
Telephone Number : 775-883-5555
Provider Enumeration Date : 08/09/2006
Last Update Date : 12/12/2024

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1447687884 — MRS. LAUREN DANIELLE TAYLOR PA-C
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89706-0674
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Directions to “CARSON MEDICAL GROUP PROFESSIONAL CORPORATION ” Practice Location

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