Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 1241 | SD |
N | 207X00000X | Orthopaedic Surgeon | 26304 | IA |
N | 207X00000X | Orthopaedic Surgeon | 47259 | MN |
NPI | 1003823170 |
---|---|
Provider Name | Walter O Carlson |
First Address | Sioux Falls, SD 57117-5116 |
Second Address | Sioux Falls, SD 57105-2135 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 16/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200010316 | RAILROAD MEDICARE (01) | SD |
6400350 | (05) | SD |
D25209 | (02) |