| Doctor Name: | MR. GERALD E CARLSON |
| NPI Number: | 1053339457 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.O |
| License Number: | 0-19 |
| Business Practice Address: | 1603 12th Ave Rd Ste. B Nampa, ID - 836867712 |
| Business Phone Number: | 2084672400 |
| Business Fax Number: | 2084676416 |
| Mailing Address: | 1603 12th Ave Rd, Ste. B NAMPA |
| State: | ID |
| Postal Code: | 836867712 |
| Phone Number: | 2084672400 |
| Fax Number: | 2084676416 |
| NPI Enumeration Date: | 07/17/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 0-19 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |