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Individual

DR. WAYNE DONALD CARLSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1500 CURVE CREST BLVD W, STILLWATER, MN 55082-6040
(651) 439-1234
(651) 439-1547
Mailing address
8170 33RD AVE S # MS 21110Q, MINNEAPOLIS, MN 55425-4516
(651) 439-1234

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
21455
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
206382400
MN
05
31578800
WI
Enumeration date
12/13/2005
Last updated
04/01/2019
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