Individual
DR. LARRY GOTFREY THIRSTRUP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1151 BARATARIA BLVD STE 3400, MARRERO, LA 70072-3083
(504) 265-8304
Mailing address
140 FAY WAY, SLIDELL, LA 70460-3212
(340) 643-4890
(985) 605-7213
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
300473
LA
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
300473
LA
207R00000X
Internal Medicine Physician
Primary
300473
LA
207RA0401X
Addiction Medicine (Internal Medicine) Physician
300473
LA
Other
Enumeration date
09/26/2012
Last updated
11/13/2024
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