MEDICARE: GINA MARIE CARTER-BEARD 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	2080H0002X	Pediatric Hospice and Palliative Medicine Physician	LL16522	OR

General Provider Information

NPI Number	:	1083815922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA MARIE CARTER-BEARD M.D.

Provider Business Mailing Address
First Line	:	2617 SE KELLY ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97202-2032
Country	:	US
Telephone Number	:	602-300-1677
Fax Number	:

Provider Business Practice Location Address
First Line	:	3181 SW SAM JACKSON PARK RD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-3011
Country	:	US
Telephone Number	:	503-418-5700
Fax Number	:

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

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	07/08/2007

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