Provider Demographics
NPI:1144763897
Name:THUNDER MEDICAL, P.C.
Entity Type:Organization
Organization Name:THUNDER MEDICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:ODOM
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:303-278-0392
Mailing Address - Street 1:3984 YOUNGFIELD ST
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-3865
Mailing Address - Country:US
Mailing Address - Phone:303-278-0392
Mailing Address - Fax:303-278-0612
Practice Address - Street 1:3984 YOUNGFIELD ST
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-3865
Practice Address - Country:US
Practice Address - Phone:303-278-0392
Practice Address - Fax:303-278-0612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic MedicineGroup - Single Specialty