Healthcare Provider Details

I. General information

NPI: 1528031630
Provider Name (Legal Business Name): TANYA ELIZABETH CARTER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 03/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9385 SW LOCUST ST # DT
TIGARD OR
97223-6632
US

IV. Provider business mailing address

9385 SW LOCUST ST
TIGARD OR
97223-6632
US

V. Phone/Fax

Practice location:
  • Phone: 503-244-4268
  • Fax: 503-244-4261
Mailing address:
  • Phone: 503-244-4268
  • Fax: 503-244-4261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO22368
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: