Provider Demographics
NPI:1356331748
Name:THOMPSON, CATHERINE W (MD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:W
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9555 SW BARNES RD
Mailing Address - Street 2:STE 301
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6663
Mailing Address - Country:US
Mailing Address - Phone:503-297-3371
Mailing Address - Fax:503-297-3371
Practice Address - Street 1:9555 SW BARNES RD
Practice Address - Street 2:STE 301
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6663
Practice Address - Country:US
Practice Address - Phone:503-297-3371
Practice Address - Fax:503-297-3371
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD13495208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR100164Medicaid
C92025Medicare UPIN
OR100164Medicaid