Provider Demographics
NPI:1851684765
Name:THOMPSON, MICHELLE BRADLEY (DO)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:BRADLEY
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 BLACK HILLS LN SW
Mailing Address - Street 2:STE A
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8144
Mailing Address - Country:US
Mailing Address - Phone:206-465-5068
Mailing Address - Fax:
Practice Address - Street 1:406 BLACK HILLS LN SW
Practice Address - Street 2:STE A
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8144
Practice Address - Country:US
Practice Address - Phone:360-754-1735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10041324207R00000X
WAOP60726268207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine