Individual
DR. GREGORY D. CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1120 W. LA VETA AVENUE, SUITE 300, ORANGE, CA 92868-4246
(714) 598-1745
(714) 941-9539
Mailing address
1120 W LA VETA AVE STE 300, ORANGE, CA 92868-4246
(714) 598-1745
(714) 941-9539
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
G65319
CA
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
G65319
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB234935
INDIVIDUAL PTAN
CA
Enumeration date
10/04/2005
Last updated
03/22/2022
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