Provider Demographics
NPI:1528249620
Name:THOMAS E DEBLOIS
Entity type:Organization
Organization Name:THOMAS E DEBLOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:DEBLOIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-265-9891
Mailing Address - Street 1:PO BOX 2031
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-0145
Mailing Address - Country:US
Mailing Address - Phone:541-265-9891
Mailing Address - Fax:541-265-9827
Practice Address - Street 1:133 NE 8TH ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-3130
Practice Address - Country:US
Practice Address - Phone:541-265-9891
Practice Address - Fax:541-265-9827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR82122084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR133060Medicare PIN