Provider Demographics
NPI:1780655845
Name:THOMPSON, JOFFREY G (MD)
Entity Type:Individual
Prefix:
First Name:JOFFREY
Middle Name:G
Last Name:THOMPSON
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 1:3035 DEMERS AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4018
Mailing Address - Country:US
Mailing Address - Phone:701-746-7521
Mailing Address - Fax:701-795-2553
Practice Address - Street 1:3035 DEMERS AVE
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4018
Practice Address - Country:US
Practice Address - Phone:701-746-7521
Practice Address - Fax:701-795-2553
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND8649207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND020006OtherBCBS ND
MN015D3THOtherBCBS MN
5613280001OtherAMINISTAR
ND11443Medicaid
MN015D3THOtherBCBS MN
ND020006OtherBCBS ND
NDH03136Medicare UPIN
ND11443Medicaid