Individual
CARROLL WAYNE THORNBURG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
725 S MESA HILLS DR, SUITE 1, BLDG. 1, EL PASO, TX 79912-5568
(915) 887-3414
(915) 585-1682
Mailing address
725 S MESA HILLS DR, SUITE 1, BLDG. 1, EL PASO, TX 79912-5568
(915) 887-3414
(915) 585-1682
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
G9230
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
E0068
—
NM
Enumeration date
07/08/2005
Last updated
11/23/2015
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