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NPI Code Detail

MEDICARE: DANE THURSTON PA

MEDICARE: DANE THURSTON PA
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
1363A00000XPhysician Assistant362840-1206UT

General Provider Information

NPI Number : 1225255235
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANE THURSTON PA
Provider Business Mailing Address
First Line : 152 N 400 W
Second Line :
City : EPHRAIM
State : UT
Zip : 84627-5549
Country : US
Telephone Number : 435-283-8400
Fax Number : 435-283-8401
Provider Business Practice Location Address
First Line : 152 N 400 W
Second Line :
City : EPHRAIM
State : UT
Zip : 84627-5549
Country : US
Telephone Number : 435-283-4065
Fax Number : 435-462-8407
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2007
Last Update Date : 08/14/2025

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Directions to “ DANE THURSTON PA” Practice Location

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