Provider Demographics
NPI:1235270075
Name:THORNE, LARRY EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:EDWARD
Last Name:THORNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1559 PROFESSIONAL PKWY
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-2858
Mailing Address - Country:US
Mailing Address - Phone:334-826-1121
Mailing Address - Fax:334-826-1149
Practice Address - Street 1:1559 PROFESSIONAL PKWY
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-2858
Practice Address - Country:US
Practice Address - Phone:334-826-1121
Practice Address - Fax:334-826-1149
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18478208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
160200OtherAAP ID
34619OtherAMERICAN BOARD PEDIATRICS
AL18478OtherALABAMA CONTR SUBST CERT
AL18478OtherALABAMA MEDICAL LICENSE
AL51597715OtherBCBS
BT4217142OtherDEA
F87828Medicare UPIN