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General NPI Number Information
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NPI Number | 1194987206
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE PEDIATRICS LLC
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Dates
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Enumeration Date | 06/30/2008
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Last Update Date | 08/03/2010
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Provider Practice Location Address
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Address Line | 11790 SW BARNES RD SUITE 140
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City | PORTLAND
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State | OR
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Zip | 97225-5934
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Country | US
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Telephone | 503-643-2100
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Fax | 503-643-7300
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Provider Business Mailing Address
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Address Line | 11790 SW BARNES RD BLG. A, SUITE 140
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City | PORTLAND
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State | OR
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Zip | 97225-5934
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Country | US
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Telephone | 503-643-2100
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Fax | 503-643-7300
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. PAUL NORMAN THOMAS
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Credential | M.D.
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Telephone | 503-643-2100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD15689
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License Number State | OR
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