Provider Demographics
NPI:1164446589
Name:PITCHFORD, THOMAS E III (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:PITCHFORD
Suffix:III
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 1:94220 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GOLD BEACH
Mailing Address - State:OR
Mailing Address - Zip Code:97444-7756
Mailing Address - Country:US
Mailing Address - Phone:541-247-3000
Mailing Address - Fax:541-247-3101
Practice Address - Street 1:525 MADRONA AVENUE
Practice Address - Street 2:
Practice Address - City:PORT ORFORD
Practice Address - State:OR
Practice Address - Zip Code:97465-9552
Practice Address - Country:US
Practice Address - Phone:541-332-3861
Practice Address - Fax:541-332-0250
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD15040208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1811939093OtherCURRY FAMILY MEDICAL'S NPI
OR1487696985OtherCURRY GENERAL HOSPITAL'S NPI
OR113530Medicaid
OR113530Medicaid
C91176Medicare UPIN
OR276235OtherCURRY FAMILY MEDICAL MEDICAID