Provider Demographics
NPI:1477507630
Name:THOMAS A THORN MD
Entity Type:Organization
Organization Name:THOMAS A THORN MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:THORN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-765-1329
Mailing Address - Street 1:532 CASTLE DR
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-3168
Mailing Address - Country:US
Mailing Address - Phone:509-765-1329
Mailing Address - Fax:509-765-1673
Practice Address - Street 1:1036 W IVY AVE
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-2049
Practice Address - Country:US
Practice Address - Phone:509-765-1329
Practice Address - Fax:509-765-1673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8801620Medicare ID - Type Unspecified