Provider Demographics
NPI:1841212610
Name:THOMPSON, ERNEST GENE JR (MD)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:GENE
Last Name:THOMPSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12902 PLANK ROAD
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:LA
Mailing Address - Zip Code:70714-4911
Mailing Address - Country:US
Mailing Address - Phone:225-774-3883
Mailing Address - Fax:225-774-7777
Practice Address - Street 1:12902 PLANK ROAD
Practice Address - Street 2:5825 AIRLINE HIGHWAY
Practice Address - City:BAKER
Practice Address - State:LA
Practice Address - Zip Code:70714-4911
Practice Address - Country:US
Practice Address - Phone:225-774-3883
Practice Address - Fax:225-774-7777
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA14216207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1312916Medicaid
D74112Medicare UPIN
LA1312916Medicaid