Basic Information
| Provider Information | |||||||||
| NPI: | 1417190166 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LARRY R. THOMAS MD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2222 NW LOVEJOY ST | ||||||||
| Address2: | SUITE #622 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972103033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032298455 | ||||||||
| FaxNumber: | 5032297028 | ||||||||
| Practice Location | |||||||||
| Address1: | 2222 NW LOVEJOY ST | ||||||||
| Address2: | SUITE #622 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972103033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032298455 | ||||||||
| FaxNumber: | 5032297028 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2009 | ||||||||
| LastUpdateDate: | 04/10/2009 | ||||||||
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| AuthorizedOfficialLastName: | THOMAS | ||||||||
| AuthorizedOfficialFirstName: | LARRY | ||||||||
| AuthorizedOfficialMiddleName: | RICHARD | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5032298455 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | MD08532 | OR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.