Healthcare Provider Details

I. General information

NPI: 1447275474
Provider Name (Legal Business Name): PETER F. CAREY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 SW GILSON ST
MCMINNVILLE OR
97128-6913
US

IV. Provider business mailing address

PO BOX 1190
MCMINNVILLE OR
97128-1190
US

V. Phone/Fax

Practice location:
  • Phone: 503-474-9218
  • Fax: 503-472-3199
Mailing address:
  • Phone: 503-474-9218
  • Fax: 403-472-3199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1217
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: