Individual
DR. JOHN ELLERT CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9764 COUNTRY CREEK WAY, DAYTON, OH 45458-9242
(937) 885-3954
Mailing address
23625 COMMERCE PARK, SUITE 204, BEACHWOOD, OH 44122-5845
(216) 255-5700
(216) 255-5701
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
35068359
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0460497
—
OH
Enumeration date
08/31/2006
Last updated
07/07/2009
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