Provider Demographics
NPI:1952482317
Name:MOREY, CARLA P (PA)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:P
Last Name:MOREY
Suffix:
Gender:F
Credentials:PA
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 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:503-215-6494
Mailing Address - Fax:
Practice Address - Street 1:1332 S SHASTA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:EAGLE POINT
Practice Address - State:OR
Practice Address - Zip Code:97524-8623
Practice Address - Country:US
Practice Address - Phone:541-826-8160
Practice Address - Fax:541-826-8197
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00439363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500604732Medicaid
S04352Medicare UPIN
106001Medicare ID - Type Unspecified