Individual
DR. DOUGLAS W CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
301 N 8TH ST, SUITE PAV4A, SPRINGFIELD, IL 62701-1041
(217) 545-8000
(217) 545-2303
Mailing address
PO BOX 19658, SPRINGFIELD, IL 62794-9658
(217) 545-8000
(217) 545-2303
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
036-136399
IL
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
036-136399
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103810102
—
MO
Enumeration date
07/17/2006
Last updated
09/27/2018
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