Individual
NELS LOYAL CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-6400
Mailing address
7125 SW GABLE PARK RD, PORTLAND, OR 97225-2625
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
MD21530
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
134767
—
OR
Enumeration date
08/03/2006
Last updated
07/08/2007
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