Basic Information
| Provider Information | |||||||||
| NPI: | 1184782302 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THRASHER | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | DOUGLAS | ||||||||
| NamePrefix: | |||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 45280 SEELEY DR | ||||||||
| Address2: | ARGYRO HEALTH CENTER, 2ND FLOOR | ||||||||
| City: | LA QUINTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922536834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7608347920 | ||||||||
| FaxNumber: | 7608347921 | ||||||||
| Practice Location | |||||||||
| Address1: | 45280 SEELEY DR | ||||||||
| Address2: | ARGYROS HEALTH CENTER, 2ND FLOOR | ||||||||
| City: | LA QUINTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922536834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7608347920 | ||||||||
| FaxNumber: | 7608347921 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2006 | ||||||||
| LastUpdateDate: | 03/01/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0102201120 | VA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | OP60091631 | WA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 20A11578 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | BT6858899 | 01 | DEA | OTHER | 005616166 | 05 | WA | MEDICAID | 005616166 | 05 | VA | MEDICAID |