Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 4286 | IA |
NPI | 1013177955 |
---|---|
Provider Name | Mr. Mark S Carlson |
First Address | Sioux City, IA 51104-3734 |
Second Address | Sioux City, IA 51104-3734 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2008 |
Last Update Date | 14/11/2016 |