Individual
DR. THOMAS L POULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
500 5TH ST, BROOKINGS, OR 97415-9702
(541) 412-2000
Mailing address
94220 4TH ST, GOLD BEACH, OR 97444-7756
(541) 247-3910
(541) 247-3109
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
MD 602 15304
WA
208800000X
Urology Physician
Primary
MD196953
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1487696985
CURRY GENERAL HOSPITAL NPI
OR
05
—
R217930
—
OR
Enumeration date
09/27/2006
Last updated
09/01/2020
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