Healthcare Provider Details

I. General information

NPI: 1255432365
Provider Name (Legal Business Name): DAVID REX THORNING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 S COLUMBIAN WAY PATHOLOGY (113)
SEATTLE WA
98108-1532
US

IV. Provider business mailing address

8612 SE 75TH PL
MERCER ISLAND WA
98040-5704
US

V. Phone/Fax

Practice location:
  • Phone: 206-764-2394
  • Fax: 206-764-2001
Mailing address:
  • Phone: 206-236-5489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberMD00012824
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: