Provider Demographics
NPI:1831378082
Name:THIRSTRUP, LARRY LEE (MD)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:LEE
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 1:200 OLYMPIA DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70460-3222
Mailing Address - Country:US
Mailing Address - Phone:985-649-7357
Mailing Address - Fax:985-641-9897
Practice Address - Street 1:609 BROWNSWITCH RD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-1233
Practice Address - Country:US
Practice Address - Phone:985-649-7357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA05574R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine