Provider Demographics
NPI:1730195694
Name:ORR, CARL ERIC (MD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:ERIC
Last Name:ORR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ERIC
Other - Middle Name:
Other - Last Name:ORR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5565 GROSSMONT CENTER DRIVE
Mailing Address - Street 2:BUILDING 1 SUITE 221
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942
Mailing Address - Country:US
Mailing Address - Phone:619-462-8100
Mailing Address - Fax:619-462-7933
Practice Address - Street 1:5565 GROSSMONT CENTER DRIVE
Practice Address - Street 2:BUILDING 1 SUITE 221
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942
Practice Address - Country:US
Practice Address - Phone:619-462-8100
Practice Address - Fax:619-462-7933
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG58899208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DA3229OtherMEDICARE RAILROAD GROUP
CA00G588990Medicaid
CAZZZ43506ZOtherBLUE SHIELD
00G588990OtherMEDI-CAL
CAGR0059320OtherMEDI-CAL GROUP NUMBER
WG58899CMedicare ID - Type Unspecified
CA00G588990Medicaid
E51129Medicare UPIN