Basic Information
| Provider Information | |||||||||
| NPI: | 1164446589 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PITCHFORD | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | E. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 94220 4TH ST | ||||||||
| Address2: | |||||||||
| City: | GOLD BEACH | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974447756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412473000 | ||||||||
| FaxNumber: | 5412473101 | ||||||||
| Practice Location | |||||||||
| Address1: | 525 MADRONA AVENUE | ||||||||
| Address2: | |||||||||
| City: | PORT ORFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974659552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413323861 | ||||||||
| FaxNumber: | 5413320250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 10/25/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | MD15040 | OR | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 1811939093 | 01 | OR | CURRY FAMILY MEDICAL'S NPI | OTHER | 1487696985 | 01 | OR | CURRY GENERAL HOSPITAL'S NPI | OTHER | 113530 | 05 | OR | MEDICAID |