Provider Demographics
NPI:1346241965
Name:THOMPSON, TODD P (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:P
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1400 US HIGHWAY 1 S
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-4211
Mailing Address - Country:US
Mailing Address - Phone:904-829-2286
Mailing Address - Fax:904-810-5687
Practice Address - Street 1:1400 US HIGHWAY 1 S
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-4211
Practice Address - Country:US
Practice Address - Phone:904-829-2286
Practice Address - Fax:904-810-5687
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84764207W00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME84764OtherFLORIDA LICENSE
FLME84764OtherFLORIDA LICENSE
FL13487ZMedicare UPIN