Provider Demographics
NPI:1013981190
Name:MU, THORNTON SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:THORNTON
Middle Name:SAMUEL
Last Name:MU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3551 ROGER BROOKE DR
Mailing Address - Street 2:SAMMC, DEPT OF PEDIATRICS
Mailing Address - City:JBSA FT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4504
Mailing Address - Country:US
Mailing Address - Phone:210-916-0378
Mailing Address - Fax:
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:MCHE-QD (CREDS)
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-916-0707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2020-12-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01060354A208000000X
HI158072080N0001X
TXP64732080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics