Provider Demographics
NPI:1013179373
Name:THOMSON, RICHARD A (CRNA)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:A
Last Name:THOMSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:RICK
Other - Middle Name:A
Other - Last Name:THOMSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:7301 N 16TH ST
Mailing Address - Street 2:STE 102
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5266
Mailing Address - Country:US
Mailing Address - Phone:480-420-4027
Mailing Address - Fax:602-535-0940
Practice Address - Street 1:280 MAPLE ST.
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520
Practice Address - Country:US
Practice Address - Phone:541-201-4000
Practice Address - Fax:541-488-7411
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60026992367500000X
AZ274546367500000X
OR201360042CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered