Healthcare Provider Details

I. General information

NPI: 1144296245
Provider Name (Legal Business Name): JOHN E THURSTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 09/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S 15TH ST
WORLAND WY
82401-3530
US

IV. Provider business mailing address

401 S 15TH ST
WORLAND WY
82401-3530
US

V. Phone/Fax

Practice location:
  • Phone: 307-347-2525
  • Fax: 307-347-3949
Mailing address:
  • Phone: 307-347-2525
  • Fax: 307-347-3949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5442A
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5008190-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: