Individual
LARISSA ANN THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2011 4TH ST, LA GRANDE, OR 97850-2511
(541) 963-4139
(541) 429-6612
Mailing address
PO BOX 1517, PENDLETON, OR 97801-0410
(877) 708-1119
(541) 278-8349
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD168475
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R184141
MEDICARE PTAN PART A
—
01
—
R184162
MEDICARE PTAN - PART B
—
Enumeration date
04/07/2012
Last updated
12/30/2025
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