Provider Demographics
NPI:1528041118
Name:THOMPSON, VICTOR JAMES (MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:JAMES
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 1:345 MAXWELL AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3972
Mailing Address - Country:US
Mailing Address - Phone:303-544-5777
Mailing Address - Fax:303-544-5775
Practice Address - Street 1:6685 GUNPARK DR EAST
Practice Address - Street 2:STE 110
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301
Practice Address - Country:US
Practice Address - Phone:303-530-3062
Practice Address - Fax:303-530-5474
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO22823207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01228238Medicaid
COM0298Medicare ID - Type Unspecified
CO01228238Medicaid
COD24163Medicare UPIN