Provider Demographics
NPI:1881666790
Name:THOMPSON, JAMES CAROL JR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:CAROL
Last Name:THOMPSON
Suffix:JR
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 1:190 N CHARLES RICHARD BEALL BLVD
Mailing Address - Street 2:
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-2271
Mailing Address - Country:US
Mailing Address - Phone:386-917-7670
Mailing Address - Fax:386-668-8604
Practice Address - Street 1:190 N CHARLES RICHARD BEALL BLVD
Practice Address - Street 2:
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-2271
Practice Address - Country:US
Practice Address - Phone:386-917-7670
Practice Address - Fax:386-668-8604
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9701174207R00000X
FLME 114276207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC131WUOtherBCBS NC
NC89131WUMedicaid
NCP00452512OtherMEDICARE RAILROAD
G68769Medicare UPIN
2007252BMedicare PIN