Individual
MR. JOHN E CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4945 WILLIAMS DR, GEORGETOWN, TX 78633-2008
(512) 819-0500
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(800) 994-0371
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
22442
SC
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
J4742
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
224420
—
SC
01
—
510446195
BCBS OF SC
SC
01
—
9199865
GHI
—
Enumeration date
11/08/2005
Last updated
01/18/2022
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