Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 10958 | MT |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 10958 | MT |
NPI | 1033165758 |
---|---|
Provider Name | Parley Kurt Thorderson |
First Address | Kalispell, MT 59901-3158 |
Second Address | Kalispell, MT 59901-3158 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2006 |
Last Update Date | 16/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1033165758 | (05) | MT |
1033165758 | BCBS (01) | MT |