Healthcare Provider Details

I. General information

NPI: 1902881006
Provider Name (Legal Business Name): PATRICK J. MCCARTHY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2005
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51600 HUNTINGTON RD STE 101
LA PINE OR
97739-8887
US

IV. Provider business mailing address

51600 HUNTINGTON RD STE 101
LA PINE OR
97739-8887
US

V. Phone/Fax

Practice location:
  • Phone: 541-536-3435
  • Fax: 541-536-8047
Mailing address:
  • Phone: 541-536-3435
  • Fax: 541-536-8047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD13438
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: