Provider Demographics
NPI:1831127547
Name:THRALL, THOMAS M (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:THRALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2615 WILLETTA ST SW
Mailing Address - Street 2:SUITE C-2
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-3404
Mailing Address - Country:US
Mailing Address - Phone:541-812-5600
Mailing Address - Fax:541-812-5610
Practice Address - Street 1:2615 WILLETTA ST SW
Practice Address - Street 2:SUITE C-2
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-3404
Practice Address - Country:US
Practice Address - Phone:541-812-5600
Practice Address - Fax:541-812-5610
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD18764207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORA66264Medicare UPIN