Basic Information
| Provider Information | |||||||||
| NPI: | 1740394378 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GERACI | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | KENT | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1219 SW 4TH AVE | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | ONTARIO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 979144500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418892668 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1219 SW 4TH AVE | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | ONTARIO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 979144500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418892668 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2006 | ||||||||
| LastUpdateDate: | 10/22/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD10368 | OR | Y | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | G87002 | CA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | MD2005-0001 | NM | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 01055830A | IN | N | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.