Healthcare Provider Details

I. General information

NPI: 1265424873
Provider Name (Legal Business Name): BRENT ROBERT THURNESS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 E 23RD ST
SIOUX FALLS SD
57105-2135
US

IV. Provider business mailing address

810 E 23RD STREET
SIOUX FALLS SD
57105-2135
US

V. Phone/Fax

Practice location:
  • Phone: 605-331-5890
  • Fax:
Mailing address:
  • Phone: 605-339-6823
  • Fax: 605-271-7617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number8016
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number32309
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: