Individual
LAWRENCE DOUGLAS CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3001 DAGGETT AVE STE 101, KLAMATH FALLS, OR 97601-1126
(541) 884-6233
(541) 880-2840
Mailing address
PO BOX 2120, PORTLAND, OR 97208-2120
(541) 884-6233
(541) 882-2840
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
G62984
CA
207RC0000X
Cardiovascular Disease Physician
Primary
MD209372
OR
207RI0011X
Interventional Cardiology Physician
G62984
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G629840
BLUE CROSS BLUE SHIELD
CA
05
—
00G629840
—
CA
Enumeration date
08/05/2006
Last updated
11/04/2022
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