Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 6643 | TX |
Y | 111NI0013X | Independent Medical Examiner | 6643 | TX |
NPI | 1205095759 |
---|---|
Provider Name | Dr. Mark Kent Carlson |
First Address | Frisco, TX 75034-1254 |
Second Address | Frisco, TX 75034-1254 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2008 |
Last Update Date | 07/01/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
605255 | (02) | TX |
605255 | (05) | TX |