Provider Demographics
NPI:1548377120
Name:CARLSON, BYRON H (MD)
Entity type:Individual
Prefix:
First Name:BYRON
Middle Name:H
Last Name:CARLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:621 S ILLINOIS AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-5489
Mailing Address - Country:US
Mailing Address - Phone:641-494-3041
Mailing Address - Fax:641-494-3059
Practice Address - Street 1:635 E US HWY
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:IA
Practice Address - Zip Code:50436-0000
Practice Address - Country:US
Practice Address - Phone:641-585-2904
Practice Address - Fax:641-585-5417
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA24816207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA19517OtherWELLMARK
IA5230862Medicaid
IAA02785Medicare UPIN
IA5230862Medicaid