Provider Demographics
NPI:1063479905
Name:THOMPSON, LEE WALTON (MD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:WALTON
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3 MOBILE INFIRMARY CIR
Mailing Address - Street 2:SUITE 305
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36607-3520
Mailing Address - Country:US
Mailing Address - Phone:251-433-5557
Mailing Address - Fax:251-433-5558
Practice Address - Street 1:3 MOBILE INFIRMARY CIR
Practice Address - Street 2:SUITE 305
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3520
Practice Address - Country:US
Practice Address - Phone:251-433-5557
Practice Address - Fax:251-433-5558
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL245602086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00126562OtherMISSISSIPPI MEDICAID
AL051507487OtherBCBS OF ALABAMA
AL009986440Medicaid
ALH37904Medicare UPIN
MS00126562OtherMISSISSIPPI MEDICAID