| Doctor Name: | DR. RUSSELL MARTIN CARLSON |
| NPI Number: | 1023271137 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DPM |
| License Number: | 135000650 |
| Business Practice Address: | 520 Valley View Dr Moline, IL - 612656152 |
| Business Phone Number: | 3097623621 |
| Business Fax Number: | 3097623690 |
| Mailing Address: | 520 Valley View Dr, MOLINE |
| State: | IL |
| Postal Code: | 612656152 |
| Phone Number: | 3097623621 |
| Fax Number: | 3097623690 |
| NPI Enumeration Date: | 07/08/2008 |
| NPI Last Update Date: | 05/06/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 135000650 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |