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Individual
JEREMY TODD CARLSON
Active
Individual
JEREMY TODD CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
50780
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0130935
MEDICA
—
05
—
614660300
—
MN
01
—
9K492CA
BCBS MN
MN
01
—
P00633143
RAILROAD MEDICARE
—
Enumeration date
08/08/2007
Last updated
02/05/2013
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