Healthcare Provider Details

I. General information

NPI: 1851333785
Provider Name (Legal Business Name): MICHAEL L THORNTON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 04/23/2008
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 TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberE-5028
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberL6673
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number060884
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: