1124108097 NPI number — DR. KEITH EDWARD THOMPSON M.D.

Table of content: DR. KEITH EDWARD THOMPSON M.D. (NPI 1124108097)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124108097 NPI number — DR. KEITH EDWARD THOMPSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
KEITH
Provider Middle Name:
EDWARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124108097
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
34800 BOB WILSON DR
Provider Second Line Business Mailing Address:
NMCSD, ATTN: MEDICAL STAFF SERVICES
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92134-1098
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-532-6460
Provider Business Mailing Address Fax Number:
619-532-6299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10666 N TORREY PINES RD # 211C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA JOLLA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-554-8605
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  0101102783 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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