Active NPI
Robert D Thornton, MD
- General Practice Physician
- Vancouver, WA
National Provider Identifier
1689668246
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 12797
- Practice address
- 4421 NE St Johns Rd
Suite F
Vancouver, WA 98661-2573 - Phone
- (360) 695-9922
- Fax
- (360) 695-1310
- NPI assigned
- Sep 9, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 12797 | WA | Primary |
Addresses
Primary practice location
4421 NE St Johns Rd
Suite F
Vancouver, WA 98661-2573
Mailing address
4421 NE St Johns Rd
Suite F
Vancouver, WA 98661-2573
Phone (360) 695-9922
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1613504 | Medicaid | WA | |
| CO4293 | Other | WA | MEDICARE RAILROAD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12797 | WA | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126224000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1332979200000",
"number": "1689668246",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4421 NE ST JOHNS RD",
"address_2": "SUITE F",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986612573",
"telephone_number": "360-695-9922",
"fax_number": "360-695-1310"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4421 NE ST JOHNS RD",
"address_2": "SUITE F",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986612573",
"telephone_number": "360-695-9922",
"fax_number": "360-695-1310"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THORNTON",
"first_name": "ROBERT",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-09",
"last_updated": "2012-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "WA",
"license": "12797",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1613504",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "CO4293",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.