Provider Demographics
NPI:1003824681
Name:THIRINGER, SHERIDAN (DO)
Entity Type:Individual
Prefix:
First Name:SHERIDAN
Middle Name:
Last Name:THIRINGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-1939
Mailing Address - Country:US
Mailing Address - Phone:503-357-2136
Mailing Address - Fax:
Practice Address - Street 1:1825 MAPLE ST
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-1939
Practice Address - Country:US
Practice Address - Phone:503-357-2136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO06506207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR235465Medicaid
08WCBCCCMedicare ID - Type Unspecified
OR235465Medicaid