1770529471 NPI number — ROBERT B THOMPSON M. D.

Table of content: ROBERT B THOMPSON M. D. (NPI 1770529471)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770529471 NPI number — ROBERT B THOMPSON M. D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
ROBERT
Provider Middle Name:
B
Provider Name Prefix Text:
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:
1770529471
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
215 N. MIDWEST BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDWEST CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-737-3491
Provider Business Mailing Address Fax Number:
405-737-5956

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 N MIDWEST BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDWEST CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73110-4320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-737-3491
Provider Business Practice Location Address Fax Number:
405-737-5956
Provider Enumeration Date:
06/21/2006

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: 207X00000X , with the licence number:  10027 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 141721400 . This is a "DEPT OF LABOR" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 100128800B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200039156 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 4351788 . This is a "AETNA" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 620198 . This is a "TRIGON" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 68G04 . This is a "EMPIRE BCBS" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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