1902144645 NPI number — DR. ANDREW JUSTIN THRASHER III PHD

Table of content: DR. ANDREW JUSTIN THRASHER III PHD (NPI 1902144645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902144645 NPI number — DR. ANDREW JUSTIN THRASHER III PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THRASHER
Provider First Name:
ANDREW
Provider Middle Name:
JUSTIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902144645
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3714 SPANISH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SULPHUR
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70665-7953
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-244-1641
Provider Business Mailing Address Fax Number:
225-208-1056

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 MAPLEWOOD DR STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SULPHUR
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70663-6100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-625-5766
Provider Business Practice Location Address Fax Number:
225-208-1056
Provider Enumeration Date:
01/30/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  1412 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com