Individual
MR. DEAN A. CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
1235 E CHEROKEE ST, SPRINGFIELD, MO 65804-2203
(417) 820-2115
(417) 820-5344
Mailing address
PO BOX 504274, SAINT LOUIS, MO 63150-4274
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2004032522
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
431560263
TRICARE
—
01
—
P00670958
RAILROAD MEDICARE
—
Enumeration date
06/21/2006
Last updated
10/25/2011
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