Provider Demographics
NPI:1366430530
Name:THORESON, J.D. (MD)
Entity type:Individual
Prefix:DR
First Name:J.D.
Middle Name:
Last Name:THORESON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 S CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-2926
Mailing Address - Country:US
Mailing Address - Phone:641-494-5350
Mailing Address - Fax:641-494-5403
Practice Address - Street 1:250 S CRESCENT DR
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-2926
Practice Address - Country:US
Practice Address - Phone:641-494-5350
Practice Address - Fax:641-494-5403
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18110207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0044909Medicaid
IA0044909Medicaid
IAA00609Medicare UPIN