Healthcare Provider Details

I. General information

NPI: 1033163266
Provider Name (Legal Business Name): JEFFREY W THORNTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 BLAKE AVE STE 101
GLENWOOD SPRINGS CO
81601-4215
US

IV. Provider business mailing address

1906 BLAKE AVE
GLENWOOD SPRINGS CO
81601-4227
US

V. Phone/Fax

Practice location:
  • Phone: 970-384-7144
  • Fax: 970-384-8115
Mailing address:
  • Phone: 970-945-6535
  • Fax: 970-945-5460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number23662
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number36617
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2008003316
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: