Individual
CARL JEFFREY CARLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2333 MOWRY AVE, SUITE 220, FREMONT, CA 94538-1700
(510) 792-2012
(510) 792-7986
Mailing address
2333 MOWRY AVE, SUITE 220, FREMONT, CA 94538-1700
(510) 792-2012
(510) 792-7986
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
G29295
CA
207RI0011X
Interventional Cardiology Physician
G29295
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G292950
BLUECROSS AND BLUESHIELD
CA
05
—
00G292950
—
CA
01
—
060006330
RAILROAD MEDICARE
CA
01
—
A44008
COMMERCIAL
CA
Enumeration date
07/12/2006
Last updated
03/18/2011
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