Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | MD00041265 | WA |
NPI | 1003840398 |
---|---|
Provider Name | Paul C Thorne |
First Address | Liberty Lake, WA 99019-0421 |
Second Address | Spokane, WA 99204-2307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 01/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7616381 | WA MEDICAID (01) | WA |
8317075 | (05) | WA |
AB32999 | MEDICARE GROUP (01) | WA |
G43001 | (02) | WA |