Provider Demographics
NPI:1538257746
Name:CARLSON, DUWAYNE A (MD)
Entity type:Individual
Prefix:
First Name:DUWAYNE
Middle Name:A
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 1:3219 CENTRAL AVE STE 102A
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-2949
Mailing Address - Country:US
Mailing Address - Phone:308-865-2600
Mailing Address - Fax:
Practice Address - Street 1:2373 G RD STE 100
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1003
Practice Address - Country:US
Practice Address - Phone:970-245-0484
Practice Address - Fax:970-241-1681
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19774207XX0801X
UT13518634-1235207XX0801X
CODR.0057590207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025863500Medicaid
NEP01070476OtherRAILROAD MEDICARE
NE278560Medicare ID - Type Unspecified
NE10025863500Medicaid
NEP01070476OtherRAILROAD MEDICARE