Individual
DR. KELLY GAYLE THORSTAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
12174 N MO PAC EXPY, SUITE A, AUSTIN, TX 78758-2910
(512) 833-7334
(512) 833-7333
Mailing address
12174 N MO PAC EXPY, SUITE A, AUSTIN, TX 78758-2910
(512) 833-7334
(512) 833-7333
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
L0651
TX
Other
Enumeration date
12/14/2005
Last updated
07/23/2007
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