MEDICARE: DR. DALLAS ARTHUR CARTER MD

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD18088	OR

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CB3544	OTHER	OR	RR MEDICARE GROUP NUMBER
3	P00281134	OTHER	OR	RR MEDICARE PTAN NUMBER

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	R0000WFBTV	OTHER	OR	GROUP PIN NUMBER
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	1407812365	OTHER	OR	NBMC NPI NUMBER-GROUP
6	930635514	OTHER	OR	GROUP TAX ID
7	MD18088	OTHER	OR	MEDICAL LICENSE OREGON

NPI Number	:	1972587764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DALLAS ARTHUR CARTER MD

Provider Business Mailing Address
First Line	:	1900 WOODLAND DR
Second Line	:
City	:	COOS BAY
State	:	OR
Zip	:	97420-0000
Country	:	US
Telephone Number	:	541-267-5151
Fax Number	:	541-266-4520

Provider Business Practice Location Address
First Line	:	1900 WOODLAND DR
Second Line	:
City	:	COOS BAY
State	:	OR
Zip	:	97420-0000
Country	:	US
Telephone Number	:	541-267-5151
Fax Number	:	541-266-4520

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

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	05/20/2013

1900 WOODLAND DRIVE
COOS BAY, OR
97420-0000

Practice Phone: 541-267-5151
Practice Fax: 541-266-4553