Provider Demographics
NPI:1275638736
Name:THOMSON, KATHRYN D (DO)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:D
Last Name:THOMSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 WESTGATE
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-9604
Mailing Address - Country:US
Mailing Address - Phone:541-276-0810
Mailing Address - Fax:541-278-2209
Practice Address - Street 1:2600 WESTGATE
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-9604
Practice Address - Country:US
Practice Address - Phone:541-276-0810
Practice Address - Fax:541-278-2209
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO13836207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR275058Medicaid
D80369Medicare UPIN
ORR114495Medicare ID - Type Unspecified