Provider Demographics
NPI:1770834012
Name:THIRSTRUP, LARRY GOTFREY (MD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:GOTFREY
Last Name:THIRSTRUP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 FAY WAY
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70460-3212
Mailing Address - Country:US
Mailing Address - Phone:340-643-4890
Mailing Address - Fax:985-605-7213
Practice Address - Street 1:1151 BARATARIA BLVD STE 3400
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3083
Practice Address - Country:US
Practice Address - Phone:504-265-8304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA300473207P00000X, 207PE0004X, 207RA0401X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine