Provider Demographics
NPI:1346229549
Name:WHITSEL, CAROL E (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:E
Last Name:WHITSEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1648
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97440-1648
Mailing Address - Country:US
Mailing Address - Phone:541-746-6816
Mailing Address - Fax:541-726-3177
Practice Address - Street 1:330 S GARDEN WAY
Practice Address - Street 2:SUITE 350
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8176
Practice Address - Country:US
Practice Address - Phone:541-746-6816
Practice Address - Fax:541-726-3177
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD17400207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR026950Medicaid
ORR135946Medicare PIN
OR026950Medicaid