Provider Demographics
NPI:1639289697
Name:THOMPSON, DOUGLAS JAMES (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:JAMES
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 1:201 CEDAR SE
Mailing Address - Street 2:SUITE S1 20
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4900
Mailing Address - Country:US
Mailing Address - Phone:505-247-3333
Mailing Address - Fax:505-224-7476
Practice Address - Street 1:201 CEDAR SE
Practice Address - Street 2:SUITE S1 20
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4900
Practice Address - Country:US
Practice Address - Phone:505-247-3333
Practice Address - Fax:505-224-7476
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM86348207V00000X, 207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Not Answered207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM14457Medicaid
NM14457Medicaid