1619938412 NPI number — PETER THOMPSON MD

Table of content: PETER THOMPSON MD (NPI 1619938412)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619938412 NPI number — PETER THOMPSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
PETER
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1619938412
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 708850
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANDY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84070-8850
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-869-2397
Provider Business Mailing Address Fax Number:
801-352-9502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1111 CRATER LAKE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEDFORD
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97504-6241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-732-5545
Provider Business Practice Location Address Fax Number:
541-732-5548
Provider Enumeration Date:
03/31/2006

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: 207R00000X , with the licence number:  MD19883 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 858464010 . This is a "BCBS-SPRINGFIELD" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: P00061232 . This is a "RR MEDICARE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: R134117 . This is a "MEDICARE-TYPE UNSPECIFIED" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 044797 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 838334015 . This is a "BCBS-ROSEBURG" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 210965 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8584463012 . This is a "BCBS-MEDFORD" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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