Individual
CLARENCE ROY CARLSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
404 W FOUNTAIN ST, ALBERT LEA, MN 56007-2437
(507) 373-2384
Mailing address
375 OAK ST, APT. 7, EMMONS, MN 56029-1031
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
34377
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
458507100
—
MN
Enumeration date
01/13/2006
Last updated
04/11/2012
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