Provider Demographics
NPI:1427033646
Name:THOMPSON, RONALD W (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:W
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:PO BOX 512185
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-0185
Mailing Address - Country:US
Mailing Address - Phone:626-775-3514
Mailing Address - Fax:
Practice Address - Street 1:2121 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2303
Practice Address - Country:US
Practice Address - Phone:310-829-8913
Practice Address - Fax:310-315-6168
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG123762085R0001X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG12376KOtherMEDICARE EL CEN
CA00G123760Medicaid
CA00G123761OtherMEDICARE TEM
CAWG12376FOtherMEDICARE SJHC
CAWG12376IOtherMEDICARE LCM
CAWG12376JOtherMEDICARE SAN PEDRO
CAWG12376COtherMEDICARE VROC
CA00G123762OtherMEDICARE SBMC
CAG12376OtherMEDICAL LICENSE
CAWG12376GOtherMEDICARE - SJMC
CA00G123761OtherMEDICARE RIV
CAG12376OtherMEDICAL LICENSE
CAWG12376COtherMEDICARE VROC
CAWG12376I LCMMedicare PIN
CAA38642Medicare UPIN