Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | DO06506 | OR |
NPI | 1003824681 |
---|---|
Provider Name | Sheridan Thiringer |
First Address | Forest Grove, OR 97116-1939 |
Second Address | Forest Grove, OR 97116-1939 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 14/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
235465 | (05) | OR |
C90910 | (02) |