Individual
MICAH THAYN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
3950 17TH ST, BAKER CITY, OR 97814-1300
(541) 523-1001
Mailing address
3950 17TH ST, BAKER CITY, OR 97814-1300
(541) 523-1001
(541) 523-1152
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA17048
OR
Other
Enumeration date
11/04/2014
Last updated
11/04/2014
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