Provider Demographics
NPI:1659356467
Name:THOMPSON, JEFFREY D (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:D
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 1:18 MYRTLE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7471
Mailing Address - Country:US
Mailing Address - Phone:541-779-2918
Mailing Address - Fax:541-779-6149
Practice Address - Street 1:18 MYRTLE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7471
Practice Address - Country:US
Practice Address - Phone:541-779-2918
Practice Address - Fax:541-779-6149
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD07147174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR203216Medicaid
ORC93939Medicare UPIN
OR0000BBWQNMedicare ID - Type Unspecified