Basic Information
| Provider Information | |||||||||
| NPI: | 1912148123 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARSON MEDICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 MOUNTAIN ST. | ||||||||
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| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758833636 | ||||||||
| FaxNumber: | 7758822382 | ||||||||
| Practice Location | |||||||||
| Address1: | 1470 MEDICAL PARKWAY | ||||||||
| Address2: | STE 110 | ||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758833636 | ||||||||
| FaxNumber: | 7758822382 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2009 | ||||||||
| LastUpdateDate: | 03/18/2009 | ||||||||
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| AuthorizedOfficialLastName: | BREEDEN | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | T. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7758833636 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | APN001101 | NV | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.