Provider Demographics
NPI:1043338940
Name:CARNEY, DOUGLAS MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:MICHAEL
Last Name:CARNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 LIBERTY ST SE STE 140
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4165
Mailing Address - Country:US
Mailing Address - Phone:503-540-0304
Mailing Address - Fax:503-540-0305
Practice Address - Street 1:960 LIBERTY ST SE STE 140
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4165
Practice Address - Country:US
Practice Address - Phone:503-540-0304
Practice Address - Fax:503-540-0305
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10043207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OROR10043OtherSTATE MEDICAL LICENSE