Provider Demographics
NPI:1134177744
Name:PHARRIS, CARLA J (MD)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:J
Last Name:PHARRIS
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 1:705 EAST ST
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:CA
Mailing Address - Zip Code:96021-2252
Mailing Address - Country:US
Mailing Address - Phone:530-690-2827
Mailing Address - Fax:530-838-9026
Practice Address - Street 1:740 SOLANO ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:CA
Practice Address - Zip Code:96021
Practice Address - Country:US
Practice Address - Phone:530-690-2827
Practice Address - Fax:530-838-9026
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60639178207R00000X
IDM5697207R00000X
CAG154757207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002252600Medicaid
1124541Medicare ID - Type Unspecified