Provider Demographics
NPI:1639200538
Name:THORNE, JOHN L (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:THORNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2938 S CREEKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-5665
Mailing Address - Country:US
Mailing Address - Phone:817-372-2068
Mailing Address - Fax:
Practice Address - Street 1:2938 S CREEKWOOD DR
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-5665
Practice Address - Country:US
Practice Address - Phone:817-372-2068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6421207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188139303Medicaid
TX8CD641OtherBCBS
TX188139302Medicaid
TXP00957376OtherRAILROAD MEDICARE
TX188139304Medicaid
TX8L20863Medicare PIN
TX188139302Medicaid
TXTXB123002Medicare PIN