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General NPI Number Information
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NPI Number | 1417128984
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Entity Type | Organization
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Legal Business Name | EASTERN OR DERMATOLOGY
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Dates
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Enumeration Date | 03/12/2008
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Last Update Date | 03/12/2008
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Provider Practice Location Address
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Address Line | 602 SE BYERS AVE
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City | PENDLETON
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State | OR
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Zip | 97801-2330
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Country | US
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Telephone | 541-966-8551
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Fax | 541-966-8554
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Provider Business Mailing Address
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Address Line | PO BOX 40
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City | PENDLETON
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State | OR
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Zip | 97801-0040
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Country | US
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Telephone | 541-966-8551
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Fax | 541-966-8554
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Authorized Official
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Title or Position | PROVIDER
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Name | JOHN M CARRINGTON
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Credential | MD
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Telephone | 541-966-8551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | MD19132
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License Number State | OR
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