Provider Demographics
NPI:1609105493
Name:THOMPSON, CLINTON EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:EDWARD
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:PO BOX 603
Mailing Address - Street 2:
Mailing Address - City:LAYTONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95454-0603
Mailing Address - Country:US
Mailing Address - Phone:707-272-0782
Mailing Address - Fax:650-745-0869
Practice Address - Street 1:60991 BELL SPRINGS ROAD
Practice Address - Street 2:
Practice Address - City:LAYTONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95454-0603
Practice Address - Country:US
Practice Address - Phone:707-272-0782
Practice Address - Fax:650-745-0869
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45458207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine