Provider Demographics
NPI:1114959210
Name:ALLUMBAUGH, THOMAS LEE (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:LEE
Last Name:ALLUMBAUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61250 SE COOMBS PL
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702
Mailing Address - Country:US
Mailing Address - Phone:541-706-5935
Mailing Address - Fax:541-706-5936
Practice Address - Street 1:61250 SE COOMBS PL
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702
Practice Address - Country:US
Practice Address - Phone:541-706-5935
Practice Address - Fax:541-706-5936
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD24468207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR227346Medicaid
OR11197862OtherCAQH ID
OR227346Medicaid