Provider Demographics
NPI:1679674188
Name:THOMPSON, GERSHOM JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:GERSHOM
Middle Name:JOSEPH
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 1:435 HUDSON STREET
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-4461
Mailing Address - Country:US
Mailing Address - Phone:707-431-7041
Mailing Address - Fax:707-431-7042
Practice Address - Street 1:435 HUDSON STREET
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-4461
Practice Address - Country:US
Practice Address - Phone:707-431-7041
Practice Address - Fax:707-431-7042
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC-232682084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C232681Medicaid
A32354Medicare UPIN
CA00C232681Medicaid