Provider Demographics
NPI:1598130197
Name:BRIAN THORNBURG, DO, PA
Entity Type:Organization
Organization Name:BRIAN THORNBURG, DO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:THORNBURG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:239-348-7337
Mailing Address - Street 1:5500 BRYSON DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-0922
Mailing Address - Country:US
Mailing Address - Phone:239-348-7337
Mailing Address - Fax:239-348-7391
Practice Address - Street 1:5500 BRYSON DR
Practice Address - Street 2:SUITE 301
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-0922
Practice Address - Country:US
Practice Address - Phone:239-348-7337
Practice Address - Fax:239-348-7391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-08
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9029208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1588702419OtherNPI FOR PROVIDER