Provider Demographics
NPI:1932445566
Name:THURSTON, PAUL BRIAN (DPM)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:BRIAN
Last Name:THURSTON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2745 REBECCA LN
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8333
Mailing Address - Country:US
Mailing Address - Phone:386-775-2012
Mailing Address - Fax:386-775-2013
Practice Address - Street 1:2745 REBECCA LN
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8333
Practice Address - Country:US
Practice Address - Phone:386-775-2012
Practice Address - Fax:386-775-2013
Is Sole Proprietor?:No
Enumeration Date:2013-01-01
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 3556213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008967700Medicaid
FL6507UOtherBC BS PROVIDER #
FLFT3848631OtherDEA
FLHH054ZMedicare PIN