Provider Demographics
NPI:1639411895
Name:WYSTRACH, CARTER C (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:CARTER
Middle Name:C
Last Name:WYSTRACH
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:KAISER PERMANENTE SUNNYSIDE MEDICAL CENTER
Mailing Address - Street 2:10180 SE SUNNYSIDE RD.
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015
Mailing Address - Country:US
Mailing Address - Phone:503-652-2880
Mailing Address - Fax:
Practice Address - Street 1:KAISER PERMANENTE SUNNYSIDE MEDICAL CENTER
Practice Address - Street 2:10180 SE SUNNYSIDE RD.
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015
Practice Address - Country:US
Practice Address - Phone:503-652-2880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA133628207P00000X
ORMD180923207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine