Provider Demographics
NPI:1285692137
Name:THOMAS, PAUL NORMAN (MD)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:NORMAN
Last Name:THOMAS
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 1:11790 SW BARNES RD BLDG A
Mailing Address - Street 2:SUITE 140
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5934
Mailing Address - Country:US
Mailing Address - Phone:503-643-2100
Mailing Address - Fax:503-643-7300
Practice Address - Street 1:11790 SW BARNES RD BLDG A
Practice Address - Street 2:SUITE 140
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5934
Practice Address - Country:US
Practice Address - Phone:503-643-2100
Practice Address - Fax:503-643-7300
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD15689208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR021993005OtherBLUE CROSS
OR301242OtherPROVIDENCE HEALTH PLAN
OR054499Medicaid
93112982997006A004OtherTRI WEST