Healthcare Provider Details

I. General information

NPI: 1780728113
Provider Name (Legal Business Name): TOMAS GIGENA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2007
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 MT. HOOD AVENUE
WOODBURN OR
97071
US

IV. Provider business mailing address

1475 MT. HOOD AVENUE
WOODBURN OR
97071
US

V. Phone/Fax

Practice location:
  • Phone: 503-982-2174
  • Fax: 503-982-4599
Mailing address:
  • Phone: 503-982-2174
  • Fax: 503-982-4599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD152408
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: