Provider Demographics
NPI:1407296429
Name:THORNTON, TIMOTHY ALLEN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:ALLEN
Last Name:THORNTON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32300 PLUMWOOD ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-2718
Mailing Address - Country:US
Mailing Address - Phone:858-245-8436
Mailing Address - Fax:
Practice Address - Street 1:32300 PLUMWOOD ST
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025-2718
Practice Address - Country:US
Practice Address - Phone:858-245-8436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-05
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant