Provider Demographics
NPI:1760496301
Name:THOMPSON, JOHN R (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 910008
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40591-0008
Mailing Address - Country:US
Mailing Address - Phone:859-260-4385
Mailing Address - Fax:859-260-4386
Practice Address - Street 1:166 PASADENA DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2973
Practice Address - Country:US
Practice Address - Phone:859-278-0319
Practice Address - Fax:859-277-9699
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY24657207RC0200X
KY24657207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64246572Medicaid
KY000000047444OtherANTHEM
KY0205705Medicare PIN
KY000000047444OtherANTHEM