Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | OR MD13729 | OR |
NPI | 1164528378 |
---|---|
Provider Name | Dr. Carrie Marie Ware |
First Address | Lake Oswego, OR 97035-1312 |
Second Address | Clackamas, OR 97015-9750 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 08/07/2007 |