Provider Demographics
NPI:1225249220
Name:THRASH, DUSTIN BRECK (MD)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:BRECK
Last Name:THRASH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BRECK
Other - Middle Name:
Other - Last Name:THRASH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5310 HARVEST HILL ROAD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230
Mailing Address - Country:US
Mailing Address - Phone:214-420-0672
Mailing Address - Fax:214-736-0512
Practice Address - Street 1:3607 OAK LAWN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4743
Practice Address - Country:US
Practice Address - Phone:469-941-4212
Practice Address - Fax:469-941-4199
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAB22108774317207R00000X
TXN4801207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine