Individual
DR. CHARLES THAYER WHITE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5330 NE GLISAN ST, STE 100, PORTLAND, OR 97213-3069
(503) 215-9700
(503) 215-9701
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD151665
OR
207QS0010X
Sports Medicine (Family Medicine) Physician
MD151665
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
025167
—
OR
Enumeration date
06/20/2007
Last updated
03/25/2021
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