Provider Demographics
NPI:1497782908
Name:THOMPSON, CHESTER QUAY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHESTER
Middle Name:QUAY
Last Name:THOMPSON
Suffix:JR
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 1:2727 S 144TH STREET
Mailing Address - Street 2:SUITE 205
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144
Mailing Address - Country:US
Mailing Address - Phone:402-778-5555
Mailing Address - Fax:
Practice Address - Street 1:2727 S 144TH STREET
Practice Address - Street 2:SUITE 205
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144
Practice Address - Country:US
Practice Address - Phone:402-778-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11216174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47058116600Medicaid
NE47058116600Medicaid
NEB67564Medicare UPIN