Provider Demographics
NPI:1710089800
Name:THOMSON, JAMES W (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:W
Last Name:THOMSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:OH
Mailing Address - Zip Code:45311-1007
Mailing Address - Country:US
Mailing Address - Phone:937-452-1201
Mailing Address - Fax:937-452-0004
Practice Address - Street 1:79 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:OH
Practice Address - Zip Code:45311-1007
Practice Address - Country:US
Practice Address - Phone:937-452-1201
Practice Address - Fax:937-452-0004
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34002392207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0278864Medicaid
OHTH0411562Medicare ID - Type Unspecified
E00608Medicare UPIN