Healthcare Provider Details

I. General information

NPI: 1184782302
Provider Name (Legal Business Name): KENNETH DOUGLAS THRASHER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45280 SEELEY DR ARGYROS HEALTH CENTER, 2ND FLOOR
LA QUINTA CA
92253-6834
US

IV. Provider business mailing address

45280 SEELEY DR ARGYRO HEALTH CENTER, 2ND FLOOR
LA QUINTA CA
92253-6834
US

V. Phone/Fax

Practice location:
  • Phone: 760-834-7920
  • Fax: 760-834-7921
Mailing address:
  • Phone: 760-834-7920
  • Fax: 760-834-7921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102201120
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP60091631
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A11578
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: