Provider Demographics
NPI:1851119317
Name:ROBERT CARLSON MD PLLC
Entity type:Organization
Organization Name:ROBERT CARLSON MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-580-6910
Mailing Address - Street 1:PO BOX 517
Mailing Address - Street 2:
Mailing Address - City:LOVELADY
Mailing Address - State:TX
Mailing Address - Zip Code:75851-0517
Mailing Address - Country:US
Mailing Address - Phone:970-580-6910
Mailing Address - Fax:
Practice Address - Street 1:1320 N UNIVERSITY DR STE A
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4270
Practice Address - Country:US
Practice Address - Phone:936-568-9600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty