Provider Demographics
NPI:1184782302
Name:THRASHER, KENNETH DOUGLAS (DO)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:DOUGLAS
Last Name:THRASHER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45280 SEELEY DR
Mailing Address - Street 2:ARGYRO HEALTH CENTER, 2ND FLOOR
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-6834
Mailing Address - Country:US
Mailing Address - Phone:760-834-7920
Mailing Address - Fax:760-834-7921
Practice Address - Street 1:45280 SEELEY DR
Practice Address - Street 2:ARGYROS HEALTH CENTER, 2ND FLOOR
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-6834
Practice Address - Country:US
Practice Address - Phone:760-834-7920
Practice Address - Fax:760-834-7921
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201120207Q00000X
WAOP60091631207Q00000X
CA20A11578207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA005616166Medicaid
VA005616166Medicaid
VA005616166Medicaid
WA005616166Medicaid
080177403Medicare PIN
VA080177403Medicare ID - Type Unspecified