Provider Demographics
NPI:1013003938
Name:THORWARD, SUL ROSS OLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUL ROSS
Middle Name:OLEN
Last Name:THORWARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:222 TONGASS DR
Mailing Address - Street 2:SEARHC CLINIC II
Mailing Address - City:SITKA
Mailing Address - State:AK
Mailing Address - Zip Code:99835-9416
Mailing Address - Country:US
Mailing Address - Phone:907-966-8611
Mailing Address - Fax:907-996-8627
Practice Address - Street 1:222 TONGASS DR
Practice Address - Street 2:SEARHC CLINIC II
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835-9416
Practice Address - Country:US
Practice Address - Phone:907-966-8611
Practice Address - Fax:907-996-8627
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH360421162084P0800X
AK53822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHA15869Medicare UPIN