Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VX0201X | Gynecologic Oncologist | 39669 | IA |
Y | 207VX0201X | Gynecologic Oncologist | Q0740 | TX |
NPI | 1528268463 |
---|---|
Provider Name | Dr. Matthew Jerome Carlson |
First Address | Dallas, TX 75284-5347 |
Second Address | Dallas, TX 75390-7208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2007 |
Last Update Date | 04/12/2014 |