Doctor Name: | TODD THORNE |
NPI Number: | 1194198929 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA |
License Number: | PA-1822 |
Business Practice Address: | 114 Pioneer Ct Jerome, ID - 833385193 |
Business Phone Number: | 2083243471 |
Business Fax Number: | 2083249191 |
Mailing Address: | 114 Pioneer Ct, JEROME |
State: | ID |
Postal Code: | 833385193 |
Phone Number: | 2083243471 |
Fax Number: | 2083249191 |
NPI Enumeration Date: | 11/02/2015 |
NPI Last Update Date: | 11/02/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | PA-1822 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |