Healthcare Provider Details

I. General information

NPI: 1326005018
Provider Name (Legal Business Name): DAVID PAUL THORNE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 17TH ST
SAINT CLOUD FL
34769-6021
US

IV. Provider business mailing address

3100 17TH ST
SAINT CLOUD FL
34769-6021
US

V. Phone/Fax

Practice location:
  • Phone: 407-892-0009
  • Fax: 407-892-3285
Mailing address:
  • Phone: 407-892-0009
  • Fax: 407-892-3285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME0069080
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: