Provider Demographics
NPI:1073538468
Name:CARLSON, DAVID L (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:CARLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1155 MILL ST # M-14
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1576
Mailing Address - Country:US
Mailing Address - Phone:775-982-5262
Mailing Address - Fax:775-982-8043
Practice Address - Street 1:5190 NEIL RD STE 215
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-6509
Practice Address - Country:US
Practice Address - Phone:775-982-7800
Practice Address - Fax:775-982-8043
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN412762084P0800X
ND64462084P0800X
NV153502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND20315OtherAMERICA'S PPO #
NDHP21429OtherHEALTHPARTNERS #
NDDA9011026962OtherPREFERRED ONE #
ND355326400Medicaid
ND1542639OtherMEDICA #
ND18506Medicaid
ND58D31CAOtherMNBS #
ND64G63CAOtherMNBS #
ND117309OtherUCARE #
ND16003OtherNDBS #
NDND200168OtherLHS #
ND18506Medicaid
ND64G63CAOtherMNBS #
NDF90315Medicare UPIN