Provider Demographics
NPI:1841227493
Name:THOMPSON, CHARLES OLIVER (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:OLIVER
Last Name:THOMPSON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:267 CHIPPEWA LANE
Mailing Address - Street 2:BOX 50 331
Mailing Address - City:LAKE ARROWHEAD
Mailing Address - State:CA
Mailing Address - Zip Code:92352
Mailing Address - Country:US
Mailing Address - Phone:909-336-6588
Mailing Address - Fax:909-336-1409
Practice Address - Street 1:24630 REDLANDS BLVD
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-4019
Practice Address - Country:US
Practice Address - Phone:909-478-7878
Practice Address - Fax:909-478-0888
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAG12782207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA38784Medicare UPIN