MEDICARE: DR. DOUGLAS MICHAEL CARNEY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	10043	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OR10043	OTHER	OR	STATE MEDICAL LICENSE

General Provider Information

NPI Number	:	1043338940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS MICHAEL CARNEY M.D.

Provider Business Mailing Address
First Line	:	960 LIBERTY ST SE STE 140
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-4165
Country	:	US
Telephone Number	:	503-540-0304
Fax Number	:	503-540-0305

Provider Business Practice Location Address
First Line	:	960 LIBERTY ST SE STE 140
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-4165
Country	:	US
Telephone Number	:	503-540-0304
Fax Number	:	503-540-0305

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	07/08/2007

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