Individual
THIEBAUT THOMAS HERZOG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2500 NE NEFF RD, BEND, OR 97701-6015
(541) 382-4321
Mailing address
2801 N GANTENBEIN AVE, PORTLAND, OR 97227-1623
(503) 276-6500
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
1114344058
WA
Other
Enumeration date
03/27/2014
Last updated
11/03/2022
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