Provider Demographics
NPI:1164453858
Name:THOMPSON, JAMES WAINWRIGHT (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WAINWRIGHT
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 1:2520 BERT KOUNS INDUSTRIAL LOOP
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3130
Mailing Address - Country:US
Mailing Address - Phone:318-686-7451
Mailing Address - Fax:318-688-4099
Practice Address - Street 1:2520 BERT KOUNS INDUSTRIAL LOOP
Practice Address - Street 2:SUITE 102
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3130
Practice Address - Country:US
Practice Address - Phone:318-686-7451
Practice Address - Fax:318-688-4099
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA015093207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1319805Medicaid
B61862Medicare UPIN
LA1319805Medicaid