Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 6884 | ND |
NPI | 1013939693 |
---|---|
Provider Name | Dr. Joseph W Carlson |
First Address | Bismarck, ND 58501-4508 |
Second Address | Bismarck, ND 58501-4508 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
18016 | (05) | ND |
7771490 | SD MEDICAID (01) | SD |
F78047 | (02) | ND |