Provider Demographics
NPI:1902003866
Name:THOMPSON, BRANDON RAY (EMT)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:RAY
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 SE CARMEN WAY
Mailing Address - Street 2:
Mailing Address - City:MADRAS
Mailing Address - State:OR
Mailing Address - Zip Code:97741-2214
Mailing Address - Country:US
Mailing Address - Phone:541-777-0359
Mailing Address - Fax:
Practice Address - Street 1:63360 NW BRITTA ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6869
Practice Address - Country:US
Practice Address - Phone:541-318-4845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health