Provider Demographics
NPI:1194901785
Name:THOMAS, GEOFFREY LEE (DO)
Entity type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:LEE
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 397
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OR
Mailing Address - Zip Code:97818-0397
Mailing Address - Country:US
Mailing Address - Phone:541-481-7212
Mailing Address - Fax:541-481-2020
Practice Address - Street 1:450 TATONE ST
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OR
Practice Address - Zip Code:97818-8076
Practice Address - Country:US
Practice Address - Phone:541-481-7212
Practice Address - Fax:541-481-2020
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO152951207Q00000X
MO2007005539207Q00000X
IDO-0593207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORDO152951OtherOREGON MEDICAL LICENSE
OR500639459Medicaid