Provider Demographics
NPI:1972510634
Name:THORSON, DAVID C (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:THORSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:731 BIELENBERG DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125
Mailing Address - Country:US
Mailing Address - Phone:612-865-4686
Mailing Address - Fax:651-730-7772
Practice Address - Street 1:731 BIELENBERG DR
Practice Address - Street 2:SUITE 107
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125
Practice Address - Country:US
Practice Address - Phone:612-865-4686
Practice Address - Fax:651-730-7772
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN30312207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN328288100Medicaid
BT0625725OtherDEA NUMBER