Healthcare Provider Details

I. General information

NPI: 1306047881
Provider Name (Legal Business Name): THOMAS JEFFREY ANDERSON II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 01/22/2026
Certification Date: 01/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25050 SE STARK ST STE 300
GRESHAM OR
97030-3388
US

IV. Provider business mailing address

200 SW MARKET ST STE 1650
PORTLAND OR
97201-5739
US

V. Phone/Fax

Practice location:
  • Phone: 503-667-8878
  • Fax: 503-667-0310
Mailing address:
  • Phone: 503-466-1668
  • Fax: 503-439-6194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD29062
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: