Healthcare Provider Details

I. General information

NPI: 1295826014
Provider Name (Legal Business Name): THOMAS PATRICK TREZONA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 09/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3783 INTERNATIONAL CT STE 200
SPRINGFIELD OR
97477-1025
US

IV. Provider business mailing address

3783 INTERNATIONAL CT STE 200
SPRINGFIELD OR
97477-1025
US

V. Phone/Fax

Practice location:
  • Phone: 541-302-6469
  • Fax: 541-302-6473
Mailing address:
  • Phone: 541-302-6469
  • Fax: 541-302-6473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberMD19268
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD19268
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: