Provider Demographics
NPI:1215936661
Name:FIRTH, THOMAS A (MD)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:A
Last Name:FIRTH
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 1:1445 GATEWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97424-1224
Mailing Address - Country:US
Mailing Address - Phone:541-942-7000
Mailing Address - Fax:541-942-5550
Practice Address - Street 1:1445 GATEWAY BLVD
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:OR
Practice Address - Zip Code:97424-0026
Practice Address - Country:US
Practice Address - Phone:541-942-7000
Practice Address - Fax:541-942-5550
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD15091207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR110155238OtherRR MEDICARE
OR070425Medicaid
OR070425Medicaid
OR100205Medicare ID - Type Unspecified