Doctor Name: | RICHARD SCOTT THORSTED |
NPI Number: | 1568704245 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 28427 |
Business Practice Address: | 3551 Roger Brooke Dr Jbsa Ft Sam Houston, TX - 782344504 |
Business Phone Number: | 2109168666 |
Business Fax Number: | |
Mailing Address: | 3551 Roger Brooke Dr, APO |
State: | AA |
Postal Code: | 782346200 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 03/20/2013 |
NPI Last Update Date: | 03/31/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 28427 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NE |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |