Individual
BRUCE A CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1501 THOMPSON ST, BLOOMER, WI 54724-1257
(715) 568-2000
Mailing address
1501 THOMPSON ST, BLOOMER, WI 54724-1257
(715) 568-2000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20840
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1700877396
—
WI
Enumeration date
11/02/2005
Last updated
03/12/2010
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