MEDICARE: DR. ROBERT R THORESON DO

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
1	207Q00000X	Family Medicine Physician	G3853	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00JX61	OTHER		BCBS

General Provider Information

NPI Number	:	1720151327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT R THORESON DO

Provider Business Mailing Address
First Line	:	11410 JOLLYVILLE ROAD
Second Line	:	STE 3101
City	:	AUSTIN
State	:	TX
Zip	:	78759-2424
Country	:	US
Telephone Number	:	512-346-3637
Fax Number	:	512-346-3953

Provider Business Practice Location Address
First Line	:	11410 JOLLYVILLE ROAD
Second Line	:	STE 3101
City	:	AUSTIN
State	:	TX
Zip	:	78759-2424
Country	:	US
Telephone Number	:	512-346-3637
Fax Number	:	512-346-3953

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	03/18/2008

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