Healthcare Provider Details

I. General information

NPI: 1962492223
Provider Name (Legal Business Name): TERRY L THRASHER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 CORONA RD STE 102
COLUMBIA MO
65203-2582
US

IV. Provider business mailing address

413 W 2ND ST
SALISBURY MO
65281-1405
US

V. Phone/Fax

Practice location:
  • Phone: 573-234-1800
  • Fax: 573-234-1799
Mailing address:
  • Phone: 660-388-7084
  • Fax: 660-388-7087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number106165
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number106165
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: