MEDICARE: DR. STEPHEN H CARSON 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
1	174400000X	Specialist	G393080	CA
2	208000000X	Pediatrics Physician	G393080	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ02551Z	OTHER	CA	BLUE SHIELD
2	330831376	OTHER	CA	COMMERCIAL
3	GR0045532	OTHER	CA	MEDI-CAL

General Provider Information

NPI Number	:	1780719872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN H CARSON M.D.

Provider Business Mailing Address
First Line	:	550 WASHINGTON ST
Second Line	:	SUITE 300
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-2213
Country	:	US
Telephone Number	:	619-297-5437
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 WASHINGTON ST
Second Line	:	SUITE 300
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-2213
Country	:	US
Telephone Number	:	619-297-5437
Fax Number	:

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

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	01/31/2012

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Directions to “ DR. STEPHEN H CARSON M.D.” Practice Location

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