Provider Demographics
NPI:1033151014
Name:THURMOND, JOHN IRA (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:IRA
Last Name:THURMOND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-225-6888
Mailing Address - Fax:817-377-6570
Practice Address - Street 1:1011 MATLOCK RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3443
Practice Address - Country:US
Practice Address - Phone:817-225-6888
Practice Address - Fax:817-377-6570
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1218207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AD153OtherBLUE CROSS
TX037428203Medicaid
H28896Medicare UPIN
TX037428203Medicaid