Individual
MR. TIMOTHY SCOTT CARRASCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
9495 SW LOCUST ST, SUITE # A, PORTLAND, OR 97223-6683
(503) 636-9011
(503) 471-0504
Mailing address
9495SWLOCUST ST A, PORTLAND, OR 97223-6683
(503) 636-9011
(503) 636-3952
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
PA00732
OR
363AS0400X
Surgical Physician Assistant
Primary
PA00732
OR
Other
Enumeration date
10/22/2007
Last updated
08/20/2015
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