Organization
CARL J CARLSON MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CATHERINE CARLSON R.N. (OFFICE MANAGER)
(510) 792-2012
Entity
Organization
Contact information
Practice address
1895 MOWRY AVE, SUITE #100, FREMONT, CA 94538-1737
(510) 792-2012
(510) 792-7986
Mailing address
1895 MOWRY AVE, SUITE #100, FREMONT, CA 94538-1737
(510) 792-2012
(510) 792-7986
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
G29295
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000169
HILL PHYSICIANS
CA
05
—
00G292950
—
CA
01
—
ZZZ26021Z
BLUECROSS AND BLUESHIELD
CA
Enumeration date
05/22/2007
Last updated
06/22/2009
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