Individual
MARK O. CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1605 DOUGLAS ST, SIOUX CITY, IA 51105-1109
(712) 234-1005
(712) 234-0015
Mailing address
1605 DOUGLAS ST, SIOUX CITY, IA 51105-1109
(712) 234-1005
(712) 234-0015
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
27247
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025457800
—
NE
05
—
2059956
—
IA
05
—
6004143
—
SD
01
—
IB1201001
MEDICARE PTAN
IA
Enumeration date
03/31/2006
Last updated
11/22/2012
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