White, Charles Thayer

White, Charles Thayer is an individual health care provider with primary practice located at 5330 Ne Glisan St Ste 100, Portland OR 97213-3069. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Sports Medicine. Allopathic & Osteopathic Physicians / Family Medicine is his primary health care specialty. White, Charles Thayer can be contacted via phone (503) 215-9700.

Contact Information

Primary practice address
5330 Ne Glisan St Ste 100 Portland OR 97213-3069
Phone: (503) 215-9700
Fax: (503) 215-9701
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X MD151665 Oregon
Allopathic & Osteopathic Physicians / Sports Medicine 207QS0010X MD151665 Oregon

Profile Details

NPI number 1740485432
LBN Legal business name White, Charles Thayer
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 20th, 2007
Last updated Mar 25th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1740485432 NPPES
Oregon MEDICAID 025167

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