Provider Demographics
NPI:1255327094
Name:THOMPSON, JOHN RUTHERFORD (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RUTHERFORD
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3233 W CHARLESTON BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1938
Mailing Address - Country:US
Mailing Address - Phone:702-388-1008
Mailing Address - Fax:702-410-8451
Practice Address - Street 1:3233 W CHARLESTON BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1938
Practice Address - Country:US
Practice Address - Phone:702-388-1008
Practice Address - Fax:702-410-8451
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV4282207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV0002470Medicaid
NV2002470Medicaid
NV0002470Medicaid
NV2002470Medicaid