Provider Demographics
NPI:1275846800
Name:THE DOCTOR'S OFFICE
Entity Type:Organization
Organization Name:THE DOCTOR'S OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENTON
Authorized Official - Middle Name:D
Authorized Official - Last Name:THRASHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-882-8221
Mailing Address - Street 1:409 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33460-4442
Mailing Address - Country:US
Mailing Address - Phone:561-582-5433
Mailing Address - Fax:561-585-0074
Practice Address - Street 1:409 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-4442
Practice Address - Country:US
Practice Address - Phone:561-582-5433
Practice Address - Fax:561-585-0074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-25
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77922207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1003975954OtherNPI
FL1003975954OtherNPI