Provider Demographics
NPI:1073659769
Name:THORDSEN, JOHN E JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:THORDSEN
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:4414 LAKE BOONE TRL
Mailing Address - Street 2:302
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7513
Mailing Address - Country:US
Mailing Address - Phone:919-782-8038
Mailing Address - Fax:919-782-8189
Practice Address - Street 1:4414 LAKE BOONE TRL STE 302
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7514
Practice Address - Country:US
Practice Address - Phone:197-828-0389
Practice Address - Fax:919-782-8189
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2020-09-24
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Provider Licenses
StateLicense IDTaxonomies
NC2011-00308207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology