Basic Information
| Provider Information | |||||||||
| NPI: | 1184607244 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARNEY | ||||||||
| FirstName: | JEAN | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 9735 SW SHADY LN | ||||||||
| Address2: | #102 | ||||||||
| City: | TIGARD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972235481 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036205614 | ||||||||
| FaxNumber: | 5035984688 | ||||||||
| Practice Location | |||||||||
| Address1: | 9735 SW SHADY LN | ||||||||
| Address2: | #102 | ||||||||
| City: | TIGARD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972235481 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036205614 | ||||||||
| FaxNumber: | 5035984688 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2005 | ||||||||
| LastUpdateDate: | 07/21/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 14305 | OR | Y | Other Service Providers | Specialist |
No ID Information.