Provider Demographics
NPI:1114412707
Name:THIROS, ANTHONY (DO)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:THIROS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 W DEER FLAT RD STE 150
Mailing Address - Street 2:
Mailing Address - City:KUNA
Mailing Address - State:ID
Mailing Address - Zip Code:83634-1266
Mailing Address - Country:US
Mailing Address - Phone:082-922-3355
Mailing Address - Fax:
Practice Address - Street 1:825 W DEER FLAT RD STE 150
Practice Address - Street 2:
Practice Address - City:KUNA
Practice Address - State:ID
Practice Address - Zip Code:83634-1266
Practice Address - Country:US
Practice Address - Phone:082-922-3355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IDMRO-1939207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program