# R LYNN CARLSON MD PC MEDICENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MediCenter
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811135247
- **Authorized official:** R LYNN CARLSON MD (MANAGING PHYSICIAN)
- **Authorized official phone:** (907) 283-9118

## Contact information

- **Practice address:** 10543 KENAI SPUR HWY, KENAI, AK 99611-7812
- **Practice address phone:** (907) 283-9118
- **Practice address fax:** (907) 283-5341
- **Mailing address:** 10543 KENAI SPUR HWY, KENAI, AK 99611-7812
- **Mailing address phone:** (907) 283-9118
- **Mailing address fax:** (907) 283-5341

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/22/2009
- **Last updated:** 02/14/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | MPG0152 | — | AK |