Provider Demographics
NPI:1124035977
Name:THOMSON, BRUCE ROBERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ROBERT
Last Name:THOMSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-2202
Mailing Address - Country:US
Mailing Address - Phone:336-578-7007
Mailing Address - Fax:
Practice Address - Street 1:507 N 5TH ST
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-2202
Practice Address - Country:US
Practice Address - Phone:336-578-7007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1373103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2816632OtherTRICARE
13107OtherCIGNA
25392000OtherMAGELLAN
5218107OtherAETNA
6135518OtherUNITED BEHAVIORAL HEALTH
5591158OtherFIRST HEALTH
0346KOtherBCBS
102673OtherMANAGED HEALTH NETWORK
225104OtherPHCS
340895OtherMAMSI
12710OtherPARTNERS
152706OtherVALUE OPTIONS
6135518OtherUNITED BEHAVIORAL HEALTH