Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 16999 | CA |
Y | 213EG0000X | General Practice | 16999 | CA |
NPI | 1003162231 |
---|---|
Provider Name | Dr. Gayne Robert Thorne |
First Address | Napa, CA 94558 |
Second Address | Napa, CA 94558 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2012 |
Last Update Date | 25/07/2012 |