Provider Demographics
NPI:1932903614
Name:CARTER, COLE DOUGLAS (CRM)
Entity type:Individual
Prefix:
First Name:COLE
Middle Name:DOUGLAS
Last Name:CARTER
Suffix:
Gender:M
Credentials:CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2589 NW EDENBOWER BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-6224
Mailing Address - Country:US
Mailing Address - Phone:541-672-8533
Mailing Address - Fax:
Practice Address - Street 1:500 SE CASS AVE STE 110
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-3165
Practice Address - Country:US
Practice Address - Phone:541-677-5520
Practice Address - Fax:855-670-1788
Is Sole Proprietor?:No
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24-CRM-3799175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist