Provider Demographics
NPI:1477656882
Name:THOMAS, STEPHEN J (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:THOMAS
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 1:17600 SW ALEXANDER STREET
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97006
Mailing Address - Country:US
Mailing Address - Phone:503-642-2525
Mailing Address - Fax:503-649-9860
Practice Address - Street 1:17600 SW ALEXANDER STREET
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97006
Practice Address - Country:US
Practice Address - Phone:503-642-2525
Practice Address - Fax:503-649-9860
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8290207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR407002OtherBLUE CROSS
WA15684OtherDEPT L & I
OR199430Medicaid
OR407002OtherBLUE CROSS
ORBHHDQMedicare ID - Type Unspecified
WA15684OtherDEPT L & I