Provider Demographics
NPI:1033165758
Name:THORDERSON, PARLEY KURT (MD)
Entity Type:Individual
Prefix:
First Name:PARLEY
Middle Name:KURT
Last Name:THORDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KURT
Other - Middle Name:
Other - Last Name:THORDERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:350 HERITAGE WAY
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3158
Mailing Address - Country:US
Mailing Address - Phone:406-752-6784
Mailing Address - Fax:406-756-4111
Practice Address - Street 1:350 HERITAGE WAY
Practice Address - Street 2:SUITE 1200
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3158
Practice Address - Country:US
Practice Address - Phone:406-752-6784
Practice Address - Fax:406-756-4111
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10958207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1033165758Medicaid
MT1033165758OtherBCBS
MT1033165758Medicaid