Provider Demographics
NPI:1548202013
Name:TONNIES, ALICIA M (MD)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:M
Last Name:TONNIES
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 1:2400 LANCASTER DR NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-1221
Mailing Address - Country:US
Mailing Address - Phone:503-361-5400
Mailing Address - Fax:503-361-5401
Practice Address - Street 1:2400 LANCASTER DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1221
Practice Address - Country:US
Practice Address - Phone:503-361-5400
Practice Address - Fax:503-361-5401
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD155795207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ933558Medicaid
I27957Medicare UPIN
102634Medicare ID - Type Unspecified