Provider Demographics
NPI:1073588679
Name:CARSON, ESTHER M (PAC)
Entity Type:Individual
Prefix:MRS
First Name:ESTHER
Middle Name:M
Last Name:CARSON
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 NE 6TH ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1252
Mailing Address - Country:US
Mailing Address - Phone:541-479-3367
Mailing Address - Fax:541-479-0215
Practice Address - Street 1:1309 NE 6TH ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1252
Practice Address - Country:US
Practice Address - Phone:541-479-3367
Practice Address - Fax:541-479-0215
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR151257363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ72586Medicare ID - Type Unspecified