Provider Demographics
NPI:1003930025
Name:THOMPSON, DOUGLAS FRANKLIN (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:FRANKLIN
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1533 IRENE DR
Mailing Address - Street 2:
Mailing Address - City:BOULDER CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89005-3611
Mailing Address - Country:US
Mailing Address - Phone:702-293-3283
Mailing Address - Fax:
Practice Address - Street 1:901 ADAMS BLVD
Practice Address - Street 2:
Practice Address - City:BOULDER CITY
Practice Address - State:NV
Practice Address - Zip Code:89005-2213
Practice Address - Country:US
Practice Address - Phone:702-293-4111
Practice Address - Fax:702-294-5717
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5553207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV20-02116Medicaid
NV01WCCFV06Medicare ID - Type Unspecified
NVC96803Medicare UPIN