1457358251 NPI number — DR. ROBERT STERLING CARR DMD

Table of content: DR. ROBERT STERLING CARR DMD (NPI 1457358251)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457358251 NPI number — DR. ROBERT STERLING CARR DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARR
Provider First Name:
ROBERT
Provider Middle Name:
STERLING
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457358251
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/20/2006
NPI Reactivation Date:
04/05/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1133
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UMATILLA
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97882-1133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-922-4561
Provider Business Mailing Address Fax Number:
541-922-2317

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UMATILLA
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97882
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-922-4561
Provider Business Practice Location Address Fax Number:
541-922-2317
Provider Enumeration Date:
07/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  5033 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1223X0400X , with the licence number: 5033 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00922500 . This is a "BLUE CROSS OF OR PROVIDER" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 048074 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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