Individual
MR. TYSON THORPE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1130 W PRAIRIE AVE, COEUR D ALENE, ID 83815-8780
(208) 209-0288
(208) 209-0289
Mailing address
PO BOX 3648, COEUR D ALENE, ID 83816-2522
(208) 620-5210
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1423
ID
363AM0700X
Medical Physician Assistant
0004137
CO
Other
Enumeration date
11/03/2014
Last updated
06/09/2021
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