Individual
BLAKE CARLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5775 WAYZATA BLVD STE 190, ST LOUIS PARK, MN 55416
(952) 541-1840
Mailing address
PO BOX 50095, SEATTLE, WA 98145-5095
(206) 543-6420
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD60476887
WA
Other
Enumeration date
05/04/2012
Last updated
05/24/2018
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