Provider Demographics
NPI:1528031630
Name:CARTER, TANYA ELIZABETH (DO)
Entity Type:Individual
Prefix:DR
First Name:TANYA
Middle Name:ELIZABETH
Last Name:CARTER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9385 SW LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-6632
Mailing Address - Country:US
Mailing Address - Phone:503-244-4268
Mailing Address - Fax:503-244-4261
Practice Address - Street 1:9385 SW LOCUST ST # DT
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-6632
Practice Address - Country:US
Practice Address - Phone:503-244-4268
Practice Address - Fax:503-244-4261
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO22368207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR130335Medicaid
OR130335Medicaid
116563Medicare ID - Type Unspecified