Active NPI
Bruce Carter, LMT
- Specialist
- Gresham, OR
National Provider Identifier
1699131334
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 19488
- Practice address
- 1748 NW Fairview Dr
Gresham, OR 97030-3842 - Phone
- (503) 492-3910
- NPI assigned
- Jan 11, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 19488 | OR | Primary |
Addresses
Primary practice location
1748 NW Fairview Dr
Gresham, OR 97030-3842
Mailing address
1748 NW Fairview Dr
Gresham, OR 97030-3842
Phone (503) 492-3910
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 19488 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19488 | OR | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1452470400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1452470400000",
"number": "1699131334",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1748 NW FAIRVIEW DR",
"city": "GRESHAM",
"state": "OR",
"postal_code": "970303842",
"telephone_number": "503-492-3910"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1748 NW FAIRVIEW DR",
"city": "GRESHAM",
"state": "OR",
"postal_code": "970303842",
"telephone_number": "503-492-3910"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARTER",
"first_name": "BRUCE",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-01-11",
"last_updated": "2016-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "OR",
"license": "19488",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "19488",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gresham, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.