Bruce A Carlson, MD
Individual provider Active NPI Family Medicine Physician · Bloomer, WI
NPI 1700877396 · NPPES record last updated Mar 12, 2010
Key facts
- NPI
- 1700877396
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 20840 (WI)
- Practice address
- 1501 Thompson St
Bloomer, WI 54724-1257 - Phone
- (715) 568-2000
- NPI assigned
- Nov 2, 2005
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20840 | WI | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 20840 | WI | Yes |
Addresses
Primary practice location
1501 Thompson St
Bloomer, WI 54724-1257
Mailing address
1501 Thompson St
Bloomer, WI 54724-1257
Phone (715) 568-2000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700877396 | Medicaid | WI |
Other providers in Bloomer, WI
- Tyler Bosshart
- Denise Brockel
- Lilah Brockman
- Kristen Ribbens Bruxvoort
- Brelynn Burzynski
- Andrea Joleen Carter
- Randall Jay Casper
- Nick Cernohous
- Victoria Christianson
- City of Bloomer
All providers in Bloomer, WI · Family Medicine Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 12, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.