Individual
JACK L. THORNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
124 COUNTRY ROAD 4955, GRAND LAKE, CO 80447-0524
(970) 531-0284
Mailing address
PO BOX 524, GRAND LAKE, CO 80447-0524
(970) 531-0284
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
15603
CO
Other
Enumeration date
10/16/2012
Last updated
10/16/2012
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