Provider Demographics
NPI:1881752913
Name:THURSTON, RICHARD K (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:K
Last Name:THURSTON
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:PO BOX 411
Mailing Address - Street 2:
Mailing Address - City:ST MARIES
Mailing Address - State:ID
Mailing Address - Zip Code:83861
Mailing Address - Country:US
Mailing Address - Phone:208-245-2769
Mailing Address - Fax:
Practice Address - Street 1:229 S 7TH STREET
Practice Address - Street 2:
Practice Address - City:ST MARIES
Practice Address - State:ID
Practice Address - Zip Code:83861
Practice Address - Country:US
Practice Address - Phone:208-245-5551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-5955207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID00010004196OtherREGENCE BS IDAHO
ID59550OtherBC IDAHO
ID59550OtherBC IDAHO
E82964Medicare UPIN