Provider Demographics
NPI:1942265277
Name:THOMPSON, WILLIAM R III (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:THOMPSON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:W.
Other - Middle Name:RALEIGH
Other - Last Name:THOMPSON
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2501 N ORANGE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4603
Mailing Address - Country:US
Mailing Address - Phone:407-303-7280
Mailing Address - Fax:407-303-7265
Practice Address - Street 1:2501 N ORANGE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4603
Practice Address - Country:US
Practice Address - Phone:407-303-7280
Practice Address - Fax:407-303-7265
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74661208600000X, 2086S0102X, 2086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2501376-00Medicaid
FLF84131Medicare UPIN
FL2501376-00Medicaid