Provider Demographics
NPI:1376518308
Name:THOMPSON, TIMOTHY FRANK (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:FRANK
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HWY 30 W
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:MS
Mailing Address - Zip Code:38652-3112
Mailing Address - Country:US
Mailing Address - Phone:662-538-7631
Mailing Address - Fax:
Practice Address - Street 1:353 HIGHWAY 15 N
Practice Address - Street 2:
Practice Address - City:PONTOTOC
Practice Address - State:MS
Practice Address - Zip Code:38863-1103
Practice Address - Country:US
Practice Address - Phone:662-490-1985
Practice Address - Fax:662-490-1989
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11446207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00010274Medicaid
MSB64172Medicare UPIN
MS080000593Medicare ID - Type Unspecified