Provider Demographics
NPI:1902805807
Name:CARLSON, DAVID J (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:CARLSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:520 MARY ST
Mailing Address - Street 2:SUITE 520
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-1682
Mailing Address - Country:US
Mailing Address - Phone:812-424-8231
Mailing Address - Fax:812-435-8794
Practice Address - Street 1:520 MARY ST
Practice Address - Street 2:SUITE 520
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1682
Practice Address - Country:US
Practice Address - Phone:812-424-8231
Practice Address - Fax:812-435-8794
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2015-05-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01025538A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64751589Medicaid
IN020021454OtherRAIL ROAD MEDICARE
IL0280273014-02Medicaid
IN000000082348OtherANTHEM BLUE CROSS/SHIELD
IN100242340AMedicaid
IN000000082348OtherANTHEM BLUE CROSS/SHIELD
IN836320FMedicare PIN