Provider Demographics
NPI:1891893327
Name:MORA, CARL SHAYNE (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:SHAYNE
Last Name:MORA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3200 SQUALICUM PKWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1932
Mailing Address - Country:US
Mailing Address - Phone:360-671-4944
Mailing Address - Fax:360-738-4593
Practice Address - Street 1:2980 SQUALICUM PKWY
Practice Address - Street 2:SUITE 301
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225
Practice Address - Country:US
Practice Address - Phone:360-671-4944
Practice Address - Fax:360-738-4593
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00036443207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8228819Medicaid
GAB04544Medicare PIN
G72834Medicare UPIN