Provider Demographics
NPI:1447411160
Name:THOMPSON, BYRON LEONARD SR (IDC)
Entity Type:Individual
Prefix:MR
First Name:BYRON
Middle Name:LEONARD
Last Name:THOMPSON
Suffix:SR
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 827 BOX 134
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09617-9998
Mailing Address - Country:US
Mailing Address - Phone:081-811-5912
Mailing Address - Fax:
Practice Address - Street 1:PSC 827
Practice Address - Street 2:BOX 1000
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09617-9998
Practice Address - Country:US
Practice Address - Phone:01130081-811-6471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital