Provider Demographics
NPI:1356768006
Name:DAVID W CARLSON MD PA
Entity type:Organization
Organization Name:DAVID W CARLSON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-240-1789
Mailing Address - Street 1:4402 BROADWAY BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-8263
Mailing Address - Country:US
Mailing Address - Phone:972-240-1789
Mailing Address - Fax:
Practice Address - Street 1:4402 BROADWAY BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-8263
Practice Address - Country:US
Practice Address - Phone:972-240-1789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXHO233261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1700961406OtherNPI
TXC14201OtherUPIN
TX1700961406OtherNPI