Provider Demographics
NPI:1568527018
Name:DUNHAM, THOMAS ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ROBERT
Last Name:DUNHAM
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 1:10373 NE HANCOCK ST
Mailing Address - Street 2:SUITE115
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-3873
Mailing Address - Country:US
Mailing Address - Phone:503-853-8631
Mailing Address - Fax:503-853-8636
Practice Address - Street 1:10373 NE HANCOCK ST
Practice Address - Street 2:SUITE115
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-3873
Practice Address - Country:US
Practice Address - Phone:503-853-8631
Practice Address - Fax:503-853-8636
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD09111207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
139407OtherMEDICARE PTAN
OR047225Medicaid
ORR139365OtherCLINIC MEDICARE PIN
ORR139365OtherCLINIC MEDICARE PIN
ORR139407Medicare PIN
OR047225Medicaid