Healthcare Provider Details

I. General information

NPI: 1952988396
Provider Name (Legal Business Name): DANIEL BRYSON THORNLEY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1698 E MCANDREWS RD STE MEDFORD
MEDFORD OR
97504-5589
US

IV. Provider business mailing address

PO BOX 31001
PASADENA CA
91110-4180
US

V. Phone/Fax

Practice location:
  • Phone: 541-732-7874
  • Fax:
Mailing address:
  • Phone: 541-732-7874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA209436
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: