Provider Demographics
NPI:1689625147
Name:THORNTON, BRIAN DANIEL
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:DANIEL
Last Name:THORNTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 N SUNRISE AVE
Mailing Address - Street 2:SUITE 611
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2924
Mailing Address - Country:US
Mailing Address - Phone:916-789-1505
Mailing Address - Fax:916-789-1513
Practice Address - Street 1:151 N SUNRISE AVE
Practice Address - Street 2:SUITE 611
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2924
Practice Address - Country:US
Practice Address - Phone:916-789-1505
Practice Address - Fax:916-789-1513
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72684207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA72684OtherMEDICAL LICENSE
CAGR0100970Medicaid
CAH56238Medicare UPIN
CAA72684OtherMEDICAL LICENSE