MEDICARE: DR. HAROLD THOMAS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	MDOOO18720	WA

General Provider Information

NPI Number	:	1639173339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HAROLD THOMAS M.D.

Provider Business Mailing Address
First Line	:	734 CARRERA LN
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97034-1668
Country	:	US
Telephone Number	:	503-636-9234
Fax Number	:

Provider Business Practice Location Address
First Line	:	734 CARRERA LN
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97034-1668
Country	:	US
Telephone Number	:	503-636-9234
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	07/08/2007

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