Provider Demographics
NPI:1720020662
Name:THOMPSON, BOBBY AARON (MD)
Entity Type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:AARON
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1015 W KINGSHIGHWAY
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-4142
Mailing Address - Country:US
Mailing Address - Phone:870-239-4076
Mailing Address - Fax:870-239-4079
Practice Address - Street 1:1015 W KINGSHIGHWAY
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-4142
Practice Address - Country:US
Practice Address - Phone:870-239-4076
Practice Address - Fax:870-239-4079
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4214207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR157098001Medicaid
ARI26429Medicare UPIN
AR157098001Medicaid