Provider Demographics
NPI:1891113486
Name:THORNTON, JAMES B (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:B
Last Name:THORNTON
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 1:500 S PRESTON ST
Mailing Address - Street 2:HSC-A, RM 113
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1702
Mailing Address - Country:US
Mailing Address - Phone:502-852-8426
Mailing Address - Fax:
Practice Address - Street 1:3900 KRESGE WAY STE 56
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4683
Practice Address - Country:US
Practice Address - Phone:502-895-7265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR3645207R00000X
KY390200000X
KY516002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100362240Medicaid