Provider Demographics
NPI:1497747646
Name:THOMPSON, BARRY V (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:V
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 1:103 E 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:CROSSETT
Mailing Address - State:AR
Mailing Address - Zip Code:71635-2915
Mailing Address - Country:US
Mailing Address - Phone:870-364-5746
Mailing Address - Fax:870-364-5745
Practice Address - Street 1:103 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:CROSSETT
Practice Address - State:AR
Practice Address - Zip Code:71635-2915
Practice Address - Country:US
Practice Address - Phone:870-364-5746
Practice Address - Fax:870-364-5745
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR2641207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR109790001Medicaid
ARD75028Medicare UPIN
AR109790001Medicaid