Provider Demographics
NPI:1306047881
Name:ANDERSON, THOMAS JEFFREY II (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JEFFREY
Last Name:ANDERSON
Suffix:II
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 1:15455 NW GREENBRIER PKWY STE 112
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-8115
Mailing Address - Country:US
Mailing Address - Phone:503-466-1668
Mailing Address - Fax:503-439-6194
Practice Address - Street 1:15455 NW GREENBRIER PKWY STE 111
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-7357
Practice Address - Country:US
Practice Address - Phone:503-531-3434
Practice Address - Fax:503-645-4544
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60094937208000000X
ORMD29062208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics