Basic Information
| Provider Information | |||||||||
| NPI: | 1073538468 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARLSON | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 W. 2ND ST. | ||||||||
| Address2: | #235D/ MS 353 | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7756828175 | ||||||||
| FaxNumber: | 7753272006 | ||||||||
| Practice Location | |||||||||
| Address1: | 5190 NEIL RD | ||||||||
| Address2: | 215 | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895026599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757844917 | ||||||||
| FaxNumber: | 7757841428 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 11/22/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 6446 | ND | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | 41276 | MN | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | 15350 | NV | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 18506 | 05 | ND | MEDICAID | 64G63CA | 01 | ND | MNBS # | OTHER | 117309 | 01 | ND | UCARE # | OTHER | 1542639 | 01 | ND | MEDICA # | OTHER | 16003 | 01 | ND | NDBS # | OTHER | 355326400 | 05 | ND | MEDICAID | ND200168 | 01 | ND | LHS # | OTHER | 20315 | 01 | ND | AMERICA'S PPO # | OTHER | DA9011026962 | 01 | ND | PREFERRED ONE # | OTHER | 58D31CA | 01 | ND | MNBS # | OTHER | HP21429 | 01 | ND | HEALTHPARTNERS # | OTHER |