Provider Demographics
NPI:1477605624
Name:THOMPSON, LESTER W (MD)
Entity Type:Individual
Prefix:
First Name:LESTER
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 34584
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1584
Mailing Address - Country:US
Mailing Address - Phone:509-241-7349
Mailing Address - Fax:509-241-7628
Practice Address - Street 1:310 15TH AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-5103
Practice Address - Country:US
Practice Address - Phone:206-326-3220
Practice Address - Fax:206-326-3930
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00014401208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8430308Medicaid
WAG8872548Medicare PIN
WAG8850290Medicare PIN
WAG8850289Medicare PIN
WAG000135151Medicare PIN
WA8430308Medicaid
WAP00265200Medicare PIN
WAE99696Medicare UPIN
WAG8850288Medicare PIN