Provider Demographics
NPI:1952391948
Name:THORNER, RICHARD ERIC (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ERIC
Last Name:THORNER
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 1:8042 WURZBACH RD
Mailing Address - Street 2:STE 280
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3818
Mailing Address - Country:US
Mailing Address - Phone:210-614-8100
Mailing Address - Fax:210-568-0311
Practice Address - Street 1:8042 WURZBACH RD
Practice Address - Street 2:STE 280
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3818
Practice Address - Country:US
Practice Address - Phone:210-614-8100
Practice Address - Fax:210-568-0311
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2477207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX132874208Medicaid
TXB26965Medicare UPIN
TX132874208Medicaid