Provider Demographics
NPI:1689786006
Name:THORNBURG, HELEN (MD)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:
Last Name:THORNBURG
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 1:6017 PINE RIDGE RD STE 148
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-3956
Mailing Address - Country:US
Mailing Address - Phone:239-348-7337
Mailing Address - Fax:239-348-7391
Practice Address - Street 1:6017 PINE RIDGE RD STE 148
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-3956
Practice Address - Country:US
Practice Address - Phone:239-348-7337
Practice Address - Fax:239-348-7391
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0089006207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268333400Medicaid
FL82102OtherBLUE SHIELD
FL82102OtherBLUE SHIELD
FL268333400Medicaid
FL82102UMedicare PIN