Provider Demographics
NPI:1184601106
Name:THRALL, MARIA L
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:L
Last Name:THRALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S PRESTON RD STE 10
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-8885
Mailing Address - Country:US
Mailing Address - Phone:469-800-5200
Mailing Address - Fax:469-800-5210
Practice Address - Street 1:111 S PRESTON RD STE 10
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-8885
Practice Address - Country:US
Practice Address - Phone:469-800-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR9156207Q00000X
MN41747207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine