Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | OTO12631 | PA |
NPI | 1891003125 |
---|---|
Provider Name | Dr. David Nylas Carlson |
First Address | Jacksonville, FL 32216-4230 |
Second Address | Jacksonville, FL 32216-4230 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2010 |
Last Update Date | 19/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
012769300 | (05) | FL |
OTO1231 | GRADUATE OSTEOPATHIC TRAINEE LICENSE NUMBER (01) | PA |