Individual
MR. MARTIN D CARLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT, MMP
Contact information
Practice address
10555 SE 82ND AVE, SUITE 104, PORTLAND, OR 97086-2374
(503) 750-5824
Mailing address
10555 SE 82ND AVE, SUITE 104, PORTLAND, OR 97086-2374
(503) 750-5824
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
4573
OR
Other
Enumeration date
08/21/2007
Last updated
08/21/2007
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