Mark Luther Carlson
Internist - Addiction Medicine
1423 N Jefferson Ave
Springfield
, Missouri 65802-1917
Mark Luther Carlson
Internist - Addiction Medicine
1423 N Jefferson Ave
Springfield
, Missouri 65802-1917
(417) 269-8851
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About
Features
Specialties
- Internist - Addiction Medicine
Languages spoken
- English
Location
First Address
- Mark Luther Carlson
- 1423 N Jefferson Ave
- Springfield, MO
- Zip : 65802-1917
- Fax : (417) 269-8851
- Phone : (417) 269-2273
Second Address
- Mark Luther Carlson
- 1423 N Jefferson Ave
- Springfield, MO
- Zip : 65802-1917
- Fax : (417) 269-8851
- Phone : (417) 269-2273
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207RA0401X | Internist - Addiction Medicine | 101949 | MO |
National Provider Identifier
| NPI | 1528192150 |
|---|---|
| Provider Name | Mark Luther Carlson |
| First Address | Springfield, MO 65802-1917 |
| Second Address | Springfield, MO 65802-1917 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 15/03/2007 |
| Last Update Date | 12/10/2018 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| E70209 | (02) | MO |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.