Provider Demographics
NPI:1275522203
Name:THOMPSON, ANDREA H (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:H
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:217 W GEORGIA AVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-6811
Mailing Address - Country:US
Mailing Address - Phone:208-463-3000
Mailing Address - Fax:208-463-3034
Practice Address - Street 1:745 S PROGRESS AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-5619
Practice Address - Country:US
Practice Address - Phone:208-884-2900
Practice Address - Fax:208-884-2979
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM5783207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010001385OtherBLUE SHIELD
ID000010001387OtherBLUE SHIELD
ID38752OtherBLUE CROSS
ID43067OtherBLUE CROSS
ID57380OtherBLUE CROSS
ID000010001386OtherBLUE SHIELD
ID000010001387OtherBLUE SHIELD
ID57380OtherBLUE CROSS