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General NPI Number Information
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NPI Number | 1720001142
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Entity Type | Individual
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Provider Name | CARLIN D. UTTERBACK M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 500 5TH ST
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City | BROOKINGS
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State | OR
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Zip | 97415-9702
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Country | US
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Telephone | 541-412-2000
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Fax | 541-412-2081
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Provider Business Mailing Address
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Address Line | 94220 4TH ST
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City | GOLD BEACH
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State | OR
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Zip | 97444-7756
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Country | US
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Telephone | 541-247-3000
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Fax | 541-247-3101
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD126309
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License Number State | OR
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