Healthcare Provider Details

I. General information

NPI: 1164528428
Provider Name (Legal Business Name): KARIN ELIZABETH THRON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550D SAINT MICHAELS DR
SANTA FE NM
87505-7717
US

IV. Provider business mailing address

550D SAINT MICHAELS DR
SANTA FE NM
87505-7717
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-4098
  • Fax: 505-216-0180
Mailing address:
  • Phone: 505-982-4098
  • Fax: 505-216-0180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number96-391
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number96391
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: