Provider Demographics
NPI:1891874756
Name:THORNTON, DEBRA L (DPM)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:L
Last Name:THORNTON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23823 LORAIN RD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-2254
Mailing Address - Country:US
Mailing Address - Phone:440-734-5662
Mailing Address - Fax:440-734-0989
Practice Address - Street 1:23823 LORAIN RD
Practice Address - Street 2:SUITE 280
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-2254
Practice Address - Country:US
Practice Address - Phone:440-734-5662
Practice Address - Fax:440-734-0989
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2390213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3416115780A13OtherBLUE CROSS/BLUE SHIELD
OH395959503OtherMEDICAL MUTUAL OF OHIO
OHTH06211961Medicaid
OH395959503OtherMEDICAL MUTUAL OF OHIO
OHTH06211961Medicaid
OH0497180001Medicare NSC