Provider Demographics
NPI:1831294651
Name:THORBURN, DAVID ERNEST (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ERNEST
Last Name:THORBURN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2161 COLORADO AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-2011
Mailing Address - Country:US
Mailing Address - Phone:209-667-2250
Mailing Address - Fax:209-667-2560
Practice Address - Street 1:2161 COLORADO AVE
Practice Address - Street 2:SUITE B
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2011
Practice Address - Country:US
Practice Address - Phone:209-667-2250
Practice Address - Fax:209-667-2560
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG370690156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA46937Medicare UPIN
CAG370690Medicare ID - Type Unspecified