Provider Demographics
NPI:1326016643
Name:THURSTON, LLOYD J (DO)
Entity type:Individual
Prefix:
First Name:LLOYD
Middle Name:J
Last Name:THURSTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2490 W 26TH AVE
Mailing Address - Street 2:BLDG A-300
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-5314
Mailing Address - Country:US
Mailing Address - Phone:303-831-9393
Mailing Address - Fax:303-831-6335
Practice Address - Street 1:2490 W 26TH AVE
Practice Address - Street 2:BLDG A-300
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-5314
Practice Address - Country:US
Practice Address - Phone:303-831-9393
Practice Address - Fax:303-831-6335
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-11
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA017832083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1005280Medicaid
IA1005280Medicaid