Provider Demographics
NPI:1326085713
Name:THOMPSON, SANDRA A (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:A
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-4510
Mailing Address - Country:US
Mailing Address - Phone:208-342-9800
Mailing Address - Fax:208-342-4223
Practice Address - Street 1:633 N 4TH ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-4510
Practice Address - Country:US
Practice Address - Phone:208-342-9800
Practice Address - Fax:208-342-4223
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM5883207L00000X, 207LP2900X
CAG156943207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID004277900Medicaid
ID1124955Medicare PIN
ID004277900Medicaid