Provider Demographics
NPI:1275591455
Name:THORNHILL, EARLE STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:EARLE
Middle Name:STEPHEN
Last Name:THORNHILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7760 N LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707-3054
Mailing Address - Country:US
Mailing Address - Phone:409-212-1533
Mailing Address - Fax:
Practice Address - Street 1:7760 N LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-3054
Practice Address - Country:US
Practice Address - Phone:409-212-1533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1379207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00338930OtherMEDICARE RAILROAD
TX8AD909OtherBLUE CROSS
TXI32278Medicare UPIN
TX8F3257Medicare PIN