Provider Demographics
NPI:1639326952
Name:THORSON, ERIC (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:THORSON
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 1:996 CASCADILLA ST
Mailing Address - Street 2:
Mailing Address - City:CRESTED BUTTE
Mailing Address - State:CO
Mailing Address - Zip Code:81224-9614
Mailing Address - Country:US
Mailing Address - Phone:303-319-5631
Mailing Address - Fax:
Practice Address - Street 1:214 6TH STREET
Practice Address - Street 2:SUITE #1
Practice Address - City:CRESTED BUTTE
Practice Address - State:CO
Practice Address - Zip Code:81224
Practice Address - Country:US
Practice Address - Phone:970-349-6749
Practice Address - Fax:888-540-4013
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2546207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO67628541Medicaid