Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 61265 | MN |
N | 207X00000X | Orthopaedic Surgeon | A111936 | CA |
Y | 207XS0106X | Orthopaedic Hand Surgeon | MD182611 | OR |
N | 207XS0106X | Orthopaedic Hand Surgeon | MD2014-0487 | NM |
NPI | 1003121849 |
---|---|
Provider Name | Cory Vernon Carlston |
First Address | Portland, OR 97216-2469 |
Second Address | Portland, OR 97216-2469 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2010 |
Last Update Date | 17/03/2018 |