Provider Demographics
NPI:1205035052
Name:BRUCE CARTER, MD PC
Entity Type:Organization
Organization Name:BRUCE CARTER, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:OLIVEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-561-7000
Mailing Address - Street 1:875 OAK ST SE
Mailing Address - Street 2:SUITE 4060
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3975
Mailing Address - Country:US
Mailing Address - Phone:503-561-7000
Mailing Address - Fax:503-375-2646
Practice Address - Street 1:875 OAK ST SE
Practice Address - Street 2:SUITE 4060
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3975
Practice Address - Country:US
Practice Address - Phone:503-561-7000
Practice Address - Fax:503-375-2646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13434208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR138224Medicare PIN