Basic Information
| Provider Information | |||||||||
| NPI: | 1891003125 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARLSON | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | NYLAS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3627 UNIVERSITY BLVD S | ||||||||
| Address2: | SUITE 700 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322164230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043995678 | ||||||||
| FaxNumber: | 9043998488 | ||||||||
| Practice Location | |||||||||
| Address1: | 3627 UNIVERSITY BLVD S | ||||||||
| Address2: | SUITE 700 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322164230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043995678 | ||||||||
| FaxNumber: | 9043998488 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2010 | ||||||||
| LastUpdateDate: | 01/19/2022 | ||||||||
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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 | 207YX0905X | OTO12631 | PA | Y | Allopathic & Osteopathic Physicians | Otolaryngology | Otolaryngology/Facial Plastic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 012769300 | 05 | FL | MEDICAID | OTO1231 | 01 | PA | GRADUATE OSTEOPATHIC TRAINEE LICENSE NUMBER | OTHER |