Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | DR.0042262 | CO |
N | 208600000X | Surgeon | DR.0042262 | CO |
Y | 2086S0129X | Vascular Surgeon | DR.0042262 | CO |
NPI | 1073590972 |
---|---|
Provider Name | Gregory Carlson |
First Address | Colorado Springs, CO 80909-5533 |
Second Address | Colorado Springs, CO 80909-5533 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2005 |
Last Update Date | 10/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
46032240 | (05) | CO |
H66974 | (02) |