Healthcare Provider Details

I. General information

NPI: 1831505338
Provider Name (Legal Business Name): DORANE THORNTON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2014
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5424 19TH ST STE 300
LUBBOCK TX
79407-2164
US

IV. Provider business mailing address

5000 BRIARWOOD AVE
MIDLAND TX
79707-2753
US

V. Phone/Fax

Practice location:
  • Phone: 806-795-4391
  • Fax: 806-796-1354
Mailing address:
  • Phone: 432-682-5385
  • Fax: 432-682-1265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA08759
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: