Provider Demographics
NPI:1326308107
Name:THOMAS, H CLAY IV (PA-C)
Entity Type:Individual
Prefix:
First Name:H
Middle Name:CLAY
Last Name:THOMAS
Suffix:IV
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3841 PIPER ST STE T382
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4694
Mailing Address - Country:US
Mailing Address - Phone:907-917-2200
Mailing Address - Fax:907-865-7944
Practice Address - Street 1:9155 SW BARNES RD
Practice Address - Street 2:STE. 240
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6625
Practice Address - Country:US
Practice Address - Phone:503-297-1419
Practice Address - Fax:503-216-2488
Is Sole Proprietor?:No
Enumeration Date:2012-05-25
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA157470363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical