Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | MD16239 | OR |
NPI | 1013992387 |
---|---|
Provider Name | Thomas Lorish |
First Address | Vancouver, WA 98682-0030 |
Second Address | Portland, OR 97225-6625 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
094672 | (05) | OR |
1060391 | (05) | WA |
E40833 | (02) |