Provider Demographics
NPI:1760880223
Name:JEFFREY THOMPSON MD
Entity Type:Organization
Organization Name:JEFFREY THOMPSON MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LANDIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-547-1255
Mailing Address - Street 1:260 STATION WAY
Mailing Address - Street 2:STE D
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-3359
Mailing Address - Country:US
Mailing Address - Phone:805-473-2828
Mailing Address - Fax:805-473-0149
Practice Address - Street 1:260 STATION WAY
Practice Address - Street 2:STE D
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3359
Practice Address - Country:US
Practice Address - Phone:805-473-2828
Practice Address - Fax:805-473-0149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG49798208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA51467Medicare PIN