Individual
DR. JOEL ANDREW CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
777 HOSPITAL WAY, BLDG A SUITE 300, POCATELLO, ID 83201-5176
(208) 233-1720
(208) 239-3403
Mailing address
777 HOSPITAL WAY, BLDG A SUITE 300, POCATELLO, ID 83201-5176
(208) 233-1720
(208) 239-3403
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
3140
IA
207V00000X
Obstetrics & Gynecology Physician
Primary
O-0407
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010156981
REGENCE-BLUE SHIELD
ID
01
—
546490
DESERET MUTUAL
ID
05
—
807508700
—
ID
01
—
P00355281
RAILROAD MEDICARE
ID
01
—
S6109
BLUE CROSS
ID
Enumeration date
01/18/2006
Last updated
07/19/2012
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