Individual
MR. KARL C CARLSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CP, BOCOP, CPT
Contact information
Practice address
725 HAMILTON STREET, SUITE D, ROANOKE RAPIDS, NC 27870-2746
(910) 391-3782
(252) 535-0078
Mailing address
PO BOX 638, ROANOKE RAPIDS, NC 27870-0638
(910) 391-3782
(252) 535-0078
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
047C0
BLUE CROSS & BLUE SHIELD
NC
05
—
7704534
—
NC
Enumeration date
04/25/2006
Last updated
12/19/2013
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