Provider Demographics
NPI:1780686261
Name:THOMPSON, ELISHIA LEON III (DO)
Entity Type:Individual
Prefix:MR
First Name:ELISHIA
Middle Name:LEON
Last Name:THOMPSON
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:9240 W UNION HILLS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-8213
Mailing Address - Country:US
Mailing Address - Phone:623-583-7400
Mailing Address - Fax:623-583-7410
Practice Address - Street 1:9240 W UNION HILLS DR STE 100
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-8213
Practice Address - Country:US
Practice Address - Phone:623-583-7400
Practice Address - Fax:623-583-7410
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ3035207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G32528Medicare UPIN
AZ22815Medicare ID - Type Unspecified