Individual
MARY THOMASON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
12442 SW SCHOLLS FERRY RD, SUITE 106, TIGARD, OR 97223-3396
(503) 216-9200
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
42607
WI
207R00000X
Internal Medicine Physician
Primary
MD27320
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
212980
—
OR
05
—
34245500
—
WI
01
—
P00604885
RR MEDICARE - PHS
OR
Enumeration date
03/30/2006
Last updated
03/25/2021
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