Individual
MR. CHRISTOPHER R CARLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C, ATC
Contact information
Practice address
4824 E BASELINE RD, SUITE 113, MESA, AZ 85206-4676
(480) 350-3800
Mailing address
PO BOX 31917, MESA, AZ 85275-1917
(480) 350-3800
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
1593
AZ
363AS0400X
Surgical Physician Assistant
Primary
1593
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
153982
—
AZ
Enumeration date
07/28/2005
Last updated
02/05/2008
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