Provider Demographics
NPI:1477844702
Name:THURSTONE, PHYLLIS BALLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:BALLEY
Last Name:THURSTONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 SAND HILL ROAD
Mailing Address - Street 2:203F
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-2616
Mailing Address - Country:US
Mailing Address - Phone:650-321-6221
Mailing Address - Fax:
Practice Address - Street 1:620 SAND HILL ROAD
Practice Address - Street 2:203F
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-2616
Practice Address - Country:US
Practice Address - Phone:650-321-6221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA18820207R00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry