Provider Demographics
NPI:1578547741
Name:THOMPSON, JEFFREY S (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:S
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:260 STATION WAY
Mailing Address - Street 2:SUITE D
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-3359
Mailing Address - Country:US
Mailing Address - Phone:805-473-2828
Mailing Address - Fax:805-473-0149
Practice Address - Street 1:260 STATION WAY
Practice Address - Street 2:SUITE D
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3359
Practice Address - Country:US
Practice Address - Phone:805-473-2828
Practice Address - Fax:805-473-0149
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG49798208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G497980OtherBLUE SHIELD
CAG49798OtherBLUE CROSS
CAG49798OtherBLUE CROSS