Provider Demographics
NPI:1740380922
Name:THOMPSON, ALEXANDER WESLEY (MD MBA MPH)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:WESLEY
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD MBA MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:DEPARTMENT OF PSYCHIATRY
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-353-6963
Mailing Address - Fax:319-356-2587
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:DEPARTMENT OF PSYCHIATRY
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-353-6963
Practice Address - Fax:319-356-2587
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-428252084P0800X, 2084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8463531Medicaid
WA8463531Medicaid
WA8863343Medicare Oscar/Certification
WA8463531Medicaid