Individual
MARK R THORSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1615 DELAWARE ST, LONGVIEW, WA 98632-2367
(360) 501-3601
(360) 501-3648
Mailing address
PO BOX 3002, LONGVIEW, WA 98632-0302
(360) 501-3601
(360) 501-3648
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD00015441
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
058339
—
OR
01
—
110194826
RR MEDICARE
—
01
—
126456
LABOR & IND.
WA
05
—
8239097
—
WA
01
—
8923178
CRIME VICTIMS
WA
Enumeration date
08/09/2005
Last updated
07/30/2012
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