Individual
JONATHAN L THORNSBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
363 E. ROUTE 66, STRAFFORD, MO 65757
(417) 736-9175
(417) 736-9178
Mailing address
PO BOX 505164, SAINT LOUIS, MO 63150-5164
(417) 829-4620
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2003014014
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255411989
—
MO
01
—
126814
BCBS
—
05
—
200568103
—
MO
01
—
250766
HEALTHLINK
—
01
—
P00453855
RAILROAD MEDICARE
—
Enumeration date
10/17/2006
Last updated
10/10/2014
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