Provider Demographics
NPI:1124058649
Name:THRASHER, KEN LEE (MD)
Entity type:Individual
Prefix:
First Name:KEN
Middle Name:LEE
Last Name:THRASHER
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:PO BOX 5607
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77508-5607
Mailing Address - Country:US
Mailing Address - Phone:713-378-3066
Mailing Address - Fax:713-378-3077
Practice Address - Street 1:4301 VISTA RD BLDG A
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-2117
Practice Address - Country:US
Practice Address - Phone:713-378-3066
Practice Address - Fax:713-378-3077
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7290207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX040147301Medicaid
TX82184FOtherBC/BS
TX0046CCOtherMEDICARE RPK GROUP #
TX82183FMedicare PIN
TX82184FOtherBC/BS
TX8L12588Medicare PIN