Provider Demographics
NPI:1114909140
Name:THORNTON, SHILPA S (MD)
Entity Type:Individual
Prefix:
First Name:SHILPA
Middle Name:S
Last Name:THORNTON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:5535 DELMAR BLVD
Mailing Address - Street 2:STE 509
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63112-3005
Mailing Address - Country:US
Mailing Address - Phone:314-367-7077
Mailing Address - Fax:314-361-1528
Practice Address - Street 1:5535 DELMAR BLVD
Practice Address - Street 2:STE 509
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63112-3005
Practice Address - Country:US
Practice Address - Phone:314-367-7077
Practice Address - Fax:314-361-1528
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2013-08-16
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Provider Licenses
StateLicense IDTaxonomies
MO108079207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209778109Medicaid
MO000006648Medicare ID - Type Unspecified
MO209778109Medicaid