Individual
BRUCE CARTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
1748 NW FAIRVIEW DR, GRESHAM, OR 97030-3842
(503) 492-3910
Mailing address
1748 NW FAIRVIEW DR, GRESHAM, OR 97030-3842
(503) 492-3910
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
19488
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
19488
—
OR
Enumeration date
01/11/2016
Last updated
01/11/2016
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