Provider Demographics
NPI:1215028881
Name:THOMPSON, ALYSSA (DO)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 S POTOMAC ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4528
Mailing Address - Country:US
Mailing Address - Phone:303-745-0000
Mailing Address - Fax:303-745-1299
Practice Address - Street 1:1400 S POTOMAC ST
Practice Address - Street 2:SUITE 110
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4528
Practice Address - Country:US
Practice Address - Phone:303-745-0000
Practice Address - Fax:303-745-1299
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43583207R00000X
ORDO27902207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR244168Medicaid
ORI44038Medicare UPIN
OR244168Medicaid