# THEODORE M. THORP M.D., PROF CORP.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265763791
- **Authorized official:** THEODORE M THORP M.D (PRESIDENT)
- **Authorized official phone:** (702) 385-1818

## Contact information

- **Practice address:** 500 S RANCHO DR, SUITE D-13, LAS VEGAS, NV 89106-4844
- **Practice address phone:** (702) 385-1818
- **Practice address fax:** (702) 385-7181
- **Mailing address:** 500 S RANCHO DR, SUITE D-13, LAS VEGAS, NV 89106-4844
- **Mailing address phone:** (702) 385-1818
- **Mailing address fax:** (702) 385-7181

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | 2979 | NV | Yes |

## Other

- **Enumeration date:** 01/22/2010
- **Last updated:** 01/22/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 002002078 | — | NV |