Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | ||
N | 222Z00000X | Podiatrist | ||
Y | 224P00000X | Prosthetist |
NPI | 1013136407 |
---|---|
Provider Name | Joseph Thornton |
First Address | Hayden, ID 83835-2620 |
Second Address | Lewiston, ID 83501-4927 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 08/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000010028073 | REGENCE BLUE SHIELD OF ID (01) | ID |
135273 | L&I (01) | WA |
8M820 | BLUE CROSS OF IDAHO (01) | ID |
9047259 | (05) | WA |