Provider Demographics
NPI:1780792457
Name:THRALL, SHARON ANN (MD)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:ANN
Last Name:THRALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2570 NW EDENBOWER BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471
Mailing Address - Country:US
Mailing Address - Phone:541-957-1111
Mailing Address - Fax:541-957-5705
Practice Address - Street 1:2570 NW EDENBOWER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471
Practice Address - Country:US
Practice Address - Phone:541-229-3301
Practice Address - Fax:541-677-7462
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR10944207Q00000X
ORMD10944207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR199638Medicaid
R145556Medicare PIN
E84629Medicare UPIN
ORR113321Medicare PIN