Provider Demographics
NPI:1619076924
Name:THOMPSON, GEORGE NIRVANO SR (DPM)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:NIRVANO
Last Name:THOMPSON
Suffix:SR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5757 WEST THUNDERBIRD ROAD
Mailing Address - Street 2:SUITE W203
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4649
Mailing Address - Country:US
Mailing Address - Phone:602-664-2333
Mailing Address - Fax:602-896-2987
Practice Address - Street 1:5757 WEST THUNDERBIRD ROAD
Practice Address - Street 2:SUITE W203
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4649
Practice Address - Country:US
Practice Address - Phone:602-664-2333
Practice Address - Fax:602-896-2987
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0403213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U37760Medicare UPIN
DPM403Medicare ID - Type Unspecified