Provider Demographics
NPI:1568448637
Name:THOMPSON, JOHN W (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:2 LIVEWELL DR
Mailing Address - Street 2:THE MEDICAL GROUP DEPT. OF GOODALL HOSPITAL
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-6762
Mailing Address - Country:US
Mailing Address - Phone:207-985-7174
Mailing Address - Fax:207-985-1304
Practice Address - Street 1:2 LIVEWELL DR
Practice Address - Street 2:THE MEDICAL GROUP DEPT. OF GOODALL HOSPITAL
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-6762
Practice Address - Country:US
Practice Address - Phone:207-985-7174
Practice Address - Fax:207-985-1304
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2011-12-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ME1385207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME288630099Medicaid
NH30224268Medicaid
MEMM3657Medicare ID - Type Unspecified
MEE12184Medicare UPIN