Provider Demographics
NPI:1063407690
Name:FLATH, THOMAS O (MD,)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:O
Last Name:FLATH
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N GRAHAM ST
Mailing Address - Street 2:SUITE 525
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1654
Mailing Address - Country:US
Mailing Address - Phone:503-249-5454
Mailing Address - Fax:503-249-5498
Practice Address - Street 1:501 N GRAHAM ST
Practice Address - Street 2:SUITE 525
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1654
Practice Address - Country:US
Practice Address - Phone:503-249-5454
Practice Address - Fax:503-249-5498
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD09254174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR256412Medicaid
OR256412Medicaid
OROOWCHHFIMedicare ID - Type Unspecified