Provider Demographics
NPI:1699837294
Name:THOMPSON, ROBERT CLAYTON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CLAYTON
Last Name:THOMPSON
Suffix:JR
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 1:238 COLFAX CAMP RD
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-8337
Mailing Address - Country:US
Mailing Address - Phone:304-216-3412
Mailing Address - Fax:
Practice Address - Street 1:238 COLFAX CAMP RD
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-8337
Practice Address - Country:US
Practice Address - Phone:304-216-3412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10972207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVAT72321Medicare UPIN