Provider Demographics
NPI:1538118799
Name:THOMPSON, THOMAS HUNTER (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:HUNTER
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 1:2508 NW MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-5510
Mailing Address - Country:US
Mailing Address - Phone:541-677-1256
Mailing Address - Fax:541-673-1160
Practice Address - Street 1:2508 NW MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-5510
Practice Address - Country:US
Practice Address - Phone:541-677-1256
Practice Address - Fax:541-673-1160
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD13952207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR74-3064196OtherTAX ID
OR221523Medicaid
OR200046321OtherRAILROAD MEDICARE
ORMD13952OtherOR STATE MEDICAL LICENSE
OR74-3064196OtherTAX ID
OR4773340001Medicare NSC
OR221523Medicaid