Provider Demographics
NPI:1639152903
Name:THOMPSON, ERIC G (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:G
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 1:1900 CENTRACARE CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-5000
Mailing Address - Country:US
Mailing Address - Phone:320-654-3630
Mailing Address - Fax:320-654-3657
Practice Address - Street 1:1900 CENTRACARE CIR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-654-3630
Practice Address - Fax:320-654-3657
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN32924207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
110420OtherU CARE
763005OtherARAZ GROUP
2116691OtherFIRST HEALTH PLAN
50A53THOtherBLUE CROSS BLUE SHIELD
COMPOtherMMSI
COMPOtherONE HEALTH PLAN
COMPOtherCHAMPUS
474795000OtherMEDICAL ASSISTANCE MA
COMPOtherGREAT WEST
0702716OtherMEDICA HEALTH PLANS
763005OtherAMERICAS PPO
990003OtherPREFERRED ONE
HP25527OtherHEALTH PARTNERS
COMPOtherGREAT WEST
160001184Medicare ID - Type Unspecified