Provider Demographics
NPI:1275688582
Name:THORNE, RONALD L
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:L
Last Name:THORNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 E OAK ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-1938
Mailing Address - Country:US
Mailing Address - Phone:602-225-9393
Mailing Address - Fax:
Practice Address - Street 1:2707 E OAK ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-1938
Practice Address - Country:US
Practice Address - Phone:602-225-9393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10800177F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ10800OtherPROVIDER FACILITY ID