| Doctor Name: | DR. RYAN MATTHEW CARLSON |
| NPI Number: | 1720221963 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | |
| Business Practice Address: | 401 Phalen Blvd - Ms 41104a Healthpartners Specialty Center 401 St. Paul, MN - 551305302 |
| Business Phone Number: | 6512547980 |
| Business Fax Number: | 6512547969 |
| Mailing Address: | 640 Jackson St, Ms 11502v SAINT PAUL |
| State: | MN |
| Postal Code: | 551012502 |
| Phone Number: | 6512547980 |
| Fax Number: | 6512547990 |
| NPI Enumeration Date: | 04/17/2009 |
| NPI Last Update Date: | 12/23/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |