Provider Demographics
NPI:1598732315
Name:THOMPSON, JAMES E JR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
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:PO BOX 986
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-0986
Mailing Address - Country:US
Mailing Address - Phone:417-256-3717
Mailing Address - Fax:417-256-3738
Practice Address - Street 1:1402 N KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-1822
Practice Address - Country:US
Practice Address - Phone:417-256-3717
Practice Address - Fax:417-256-3738
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5G97207Q00000X
ARN6920207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202379046Medicaid
MOA29001Medicare UPIN
MO000090739Medicare ID - Type Unspecified