Provider Demographics
NPI:1376526020
Name:THORNHILL, REX E (DPM)
Entity Type:Individual
Prefix:DR
First Name:REX
Middle Name:E
Last Name:THORNHILL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 9TH ST
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446
Mailing Address - Country:US
Mailing Address - Phone:805-239-3136
Mailing Address - Fax:805-239-3137
Practice Address - Street 1:806 9TH ST.
Practice Address - Street 2:SUITE 2C
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446
Practice Address - Country:US
Practice Address - Phone:805-239-3136
Practice Address - Fax:805-239-3137
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000E3592213E00000X
CA0263310002332B00000X
CAE3592213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E35920Medicaid
CAE3592OtherBLUE CROSS PIN
CA000E35920OtherBLUE SHIELD PIN
CA000E35920Medicaid
CA000E35920OtherBLUE SHIELD PIN
E3592AMedicare PIN
CAE3592OtherBLUE CROSS PIN