Provider Demographics
NPI:1477669075
Name:THOMPSON, DWIGHT E (PA-C)
Entity Type:Individual
Prefix:
First Name:DWIGHT
Middle Name:E
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N OAK ST
Mailing Address - Street 2:
Mailing Address - City:TOWNSEND
Mailing Address - State:MT
Mailing Address - Zip Code:59644-2306
Mailing Address - Country:US
Mailing Address - Phone:406-266-5204
Mailing Address - Fax:406-266-4428
Practice Address - Street 1:530 3RD ST NW
Practice Address - Street 2:
Practice Address - City:HARLOWTON
Practice Address - State:MT
Practice Address - Zip Code:59036-0287
Practice Address - Country:US
Practice Address - Phone:406-632-4351
Practice Address - Fax:406-632-3172
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT82363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0432458Medicaid
MT0432458Medicaid
R10598Medicare UPIN