Provider Demographics
NPI:1861471088
Name:THOMPSON, ROBERT CAMPBELL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CAMPBELL
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 1:495 KLONDIKE AVE
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-7632
Mailing Address - Country:US
Mailing Address - Phone:907-226-2109
Mailing Address - Fax:907-226-2109
Practice Address - Street 1:495 KLONDIKE AVE
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7632
Practice Address - Country:US
Practice Address - Phone:907-226-2109
Practice Address - Fax:907-226-2109
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR-4556174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR128341001Medicaid
AR5J923Medicare ID - Type Unspecified
ARD77578Medicare UPIN