Provider Demographics
NPI:1033163266
Name:THORNTON, JEFFREY W (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:W
Last Name:THORNTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 BLAKE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-4227
Mailing Address - Country:US
Mailing Address - Phone:970-945-6535
Mailing Address - Fax:970-945-5460
Practice Address - Street 1:1830 BLAKE AVE STE 101
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-4215
Practice Address - Country:US
Practice Address - Phone:970-384-7144
Practice Address - Fax:970-384-8115
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE236622084N0400X
IA366172084N0400X
MO20080033162084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025242300Medicaid
MO1033163266Medicaid
IA1718106Medicaid
IA2718106Medicaid
CO9000185327Medicaid
IA0718106Medicaid
NEP00325033OtherRR MEDICARE
IA13804OtherWELLMARK - SHENANDOAH
NE250469OtherMIDLANDS CHOICE
NE95878OtherWELLMARK - 4242 FARNAM
MO1033163266Medicaid
IA2718106Medicaid
MOMA1024001Medicare PIN