Individual
JESSICA R CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
94220 4TH ST, GOLD BEACH, OR 97444-7756
(541) 247-3910
(541) 247-3109
Mailing address
94220 4TH ST, GOLD BEACH, OR 97444-7756
(541) 247-3000
(541) 247-3104
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD176604
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1487696985
CURRY GENERAL HOSPITAL NPI
OR
05
—
500706467
—
OR
Enumeration date
06/20/2011
Last updated
09/16/2020
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