Provider Demographics
NPI:1578844452
Name:LARRY E. THORNE MD LLC
Entity type:Organization
Organization Name:LARRY E. THORNE MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:THORNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:334-826-1121
Mailing Address - Street 1:1559 PROFESSIONAL PKWY
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-2858
Mailing Address - Country:US
Mailing Address - Phone:334-826-1121
Mailing Address - Fax:334-826-1149
Practice Address - Street 1:1559 PROFESSIONAL PKWY
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-2858
Practice Address - Country:US
Practice Address - Phone:334-826-1121
Practice Address - Fax:334-826-1149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18478208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL18478OtherALABAMA MEDICAL LICENSE
AL18478OtherALABAMA CONTR SUBST CERT
AL34619OtherAMERICAN BOARD PEDIATRICS
AL132048Medicaid
AL51118875OtherBCBS OF AL
AL160200OtherAAP ID
AL160200OtherAAP ID
AL132048Medicaid