Provider Demographics
NPI:1295826014
Name:TREZONA, THOMAS PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:PATRICK
Last Name:TREZONA
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 1:3783 INTERNATIONAL CT
Mailing Address - Street 2:STE 200
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-1025
Mailing Address - Country:US
Mailing Address - Phone:541-302-6469
Mailing Address - Fax:541-302-6473
Practice Address - Street 1:3783 INTERNATIONAL CT STE 200
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-1025
Practice Address - Country:US
Practice Address - Phone:541-302-6469
Practice Address - Fax:541-302-6473
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD192682086X0206X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR076802Medicaid
ORR109447Medicare ID - Type Unspecified
OR076802Medicaid