Individual
JOHN R CARLSON
Active
Individual
JOHN R CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
G40653
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G406531
MEDICARE PTAN
CA
01
—
AW372Y
MEDICARE RAILROAD
CA
Enumeration date
07/07/2005
Last updated
08/14/2022
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