Provider Demographics
NPI:1760453781
Name:THOMSON, JAMES F (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:F
Last Name:THOMSON
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 1:1102 E LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:EMMETT
Mailing Address - State:ID
Mailing Address - Zip Code:83617-2713
Mailing Address - Country:US
Mailing Address - Phone:208-365-6004
Mailing Address - Fax:208-365-3589
Practice Address - Street 1:1102 E LOCUST ST
Practice Address - Street 2:
Practice Address - City:EMMETT
Practice Address - State:ID
Practice Address - Zip Code:83617-2713
Practice Address - Country:US
Practice Address - Phone:208-365-6004
Practice Address - Fax:208-365-3589
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM4640207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010158836OtherREGENCE BLUE SHIELD
ID40659OtherBLUE CROSS
ID40659OtherBLUE CROSS
ID1115740Medicare ID - Type Unspecified