Provider Demographics
NPI:1942348727
Name:THOMPSON, BRUCE F (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:F
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 1:403 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-2205
Mailing Address - Country:US
Mailing Address - Phone:631-862-7062
Mailing Address - Fax:631-862-7114
Practice Address - Street 1:403 LAKE AVE
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-2205
Practice Address - Country:US
Practice Address - Phone:631-862-7062
Practice Address - Fax:631-862-7114
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166049-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY687964OtherUNITED HEALTHCARE
NY134AU1OtherBLUE CROSS BLUE SHIELD
NY166049-1OtherLICENSE #
NYCP575OtherOXFORD ID#
NY166049-1OtherWORKERS COMPENSATION
NY46031OtherVYTRA ID #
NY166049-1Medicaid
NY061638829OtherTAX ID #
NYCP575OtherOXFORD ID#
NY46031OtherVYTRA ID #