Individual
RICHARD LEONARD CARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
810 S 6TH ST, MONTICELLO, IN 47960-8201
(574) 583-2575
(574) 583-8945
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01026206A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000079537
BLUE SHEILD
IN
01
—
000000742808
ANTHEM PROVIDER NUMBER
IN
05
—
100474970
—
IN
01
—
P00139770
PALMETTO MEDICARE
IN
Enumeration date
04/06/2006
Last updated
07/19/2012
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