Provider Demographics
NPI:1518233766
Name:JEANNE, THOMAS LUCIEN (MD, MPH)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:LUCIEN
Last Name:JEANNE
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 NE OREGON ST STE 930
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2187
Mailing Address - Country:US
Mailing Address - Phone:971-673-1222
Mailing Address - Fax:
Practice Address - Street 1:800 NE OREGON ST STE 930
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2187
Practice Address - Country:US
Practice Address - Phone:971-673-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-31
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD1715212083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine