Healthcare Provider Details

I. General information

NPI: 1134392939
Provider Name (Legal Business Name): MICHAEL L. THORNTON, D.O., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2008
Last Update Date: 04/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 E DEBBIE LN STE 102-318
MANSFIELD TX
76063-3305
US

IV. Provider business mailing address

1301 E DEBBIE LN STE 102-318
MANSFIELD TX
76063-3305
US

V. Phone/Fax

Practice location:
  • Phone: 817-477-9000
  • Fax: 817-887-5924
Mailing address:
  • Phone: 817-477-9000
  • Fax: 817-887-5924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberL6673
License Number StateTX

VIII. Authorized Official

Name: DR. MICHAEL L THORNTON
Title or Position: PRESIDENT
Credential: D.O.
Phone: 817-477-9000