Provider Demographics
NPI:1073567632
Name:THORN, KERI J (MD)
Entity Type:Individual
Prefix:MS
First Name:KERI
Middle Name:J
Last Name:THORN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 6TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:RONAN
Mailing Address - State:MT
Mailing Address - Zip Code:59864-2634
Mailing Address - Country:US
Mailing Address - Phone:406-676-4441
Mailing Address - Fax:406-676-0835
Practice Address - Street 1:107 6TH AVE SW
Practice Address - Street 2:
Practice Address - City:RONAN
Practice Address - State:MT
Practice Address - Zip Code:59864-2634
Practice Address - Country:US
Practice Address - Phone:406-676-4441
Practice Address - Fax:406-676-0835
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10516207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG76280Medicare UPIN
WA8863782Medicare PIN
MT152724Medicaid
MT93106OtherBLUE CROSS
WAG76280Medicare UPIN
WA8474710Medicaid