Individual
BRUCE D CARLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
236 E NEWPORT AVE, HERMISTON, OR 97838-2449
(541) 567-1137
(541) 567-2336
Mailing address
236 E NEWPORT AVE, HERMISTON, OR 97838-2449
(541) 567-1137
(541) 567-2336
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD07786
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080385000
BLUE CROSS BLUE SHIELD
OR
05
—
182817
—
OR
05
—
223149
—
OR
Enumeration date
12/26/2006
Last updated
12/29/2015
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