Provider Demographics
NPI:1568467892
Name:PHIPPS, THOMAS A (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:PHIPPS
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 1:19260 SW 65TH AVE
Mailing Address - Street 2:STE 280
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-5708
Mailing Address - Country:US
Mailing Address - Phone:503-692-2850
Mailing Address - Fax:503-692-4465
Practice Address - Street 1:19260 SW 65TH AVE
Practice Address - Street 2:STE 280
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-5708
Practice Address - Country:US
Practice Address - Phone:503-692-2850
Practice Address - Fax:503-692-4465
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD147302084N0400X
OR147302084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR175778Medicaid
OR175778Medicaid
OR00WDBBNCMedicare ID - Type Unspecified