Provider Demographics
NPI:1740394378
Name:GERACI, THOMAS KENT (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:KENT
Last Name:GERACI
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 1:1219 SW 4TH AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-4500
Mailing Address - Country:US
Mailing Address - Phone:541-889-2668
Mailing Address - Fax:
Practice Address - Street 1:1219 SW 4TH AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-4500
Practice Address - Country:US
Practice Address - Phone:541-889-2668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2011-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD10368208000000X
CAG87002208000000X
NMMD2005-0001208000000X
IN01055830A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR931141856OtherTIN