Basic Information
| Provider Information | |||||||||
| NPI: | 1326002601 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAYS | ||||||||
| FirstName: | THELMA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5319 SW WESTGATE DR | ||||||||
| Address2: | 241 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972212432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032977223 | ||||||||
| FaxNumber: | 5032977603 | ||||||||
| Practice Location | |||||||||
| Address1: | 11782 SW BARNES RD | ||||||||
| Address2: | BLDG C 200 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039064300 | ||||||||
| FaxNumber: | 5039064333 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2006 | ||||||||
| LastUpdateDate: | 01/31/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD17458 | OR | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 046362 | 05 | OR | MEDICAID |