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NPI Code Detail

MEDICARE: GREGORY ROBERT THORESON M.D.

MEDICARE: GREGORY ROBERT THORESON M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208800000XUrology PhysicianQ4316TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093034126
Entity Type Code : Individual
Provider Name (Legal Business Name) : GREGORY ROBERT THORESON M.D.
Provider Business Mailing Address
First Line : 3600 GASTON AVE
Second Line : SUITE 1205
City : DALLAS
State : TX
Zip : 75246-1800
Country : US
Telephone Number : 214-692-8262
Fax Number : 214-696-4190
Provider Business Practice Location Address
First Line : 3417 GASTON AVE
Second Line : SUITE 830
City : DALLAS
State : TX
Zip : 75246-0830
Country : US
Telephone Number : 214-826-6021
Fax Number : 214-823-9745
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2010
Last Update Date : 01/19/2017

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