Provider Demographics
NPI:1992975791
Name:CARLSON, BRETT (MD)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:CARLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 S CRESCENT DRIVE
Mailing Address - Street 2:MASON CITY CLINIC
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401
Mailing Address - Country:US
Mailing Address - Phone:641-494-5412
Mailing Address - Fax:
Practice Address - Street 1:250 S CRESCENT DRIVE
Practice Address - Street 2:MASON CITY CLINIC
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401
Practice Address - Country:US
Practice Address - Phone:641-494-5412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-53630207RC0000X
MN53865207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1992975791Medicaid
MN1992975791Medicaid
MI1992975791Medicaid
MN060003693Medicare PIN