Provider Demographics
NPI:1982647202
Name:THOMPSON, ANGELA MARIE (MD)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MARIE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MARIE
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:540 E JEFFERSON STREET
Mailing Address - Street 2:SUITE 106
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-2479
Mailing Address - Country:US
Mailing Address - Phone:319-354-2653
Mailing Address - Fax:319-339-1364
Practice Address - Street 1:500 E MARKET STREET
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-2689
Practice Address - Country:US
Practice Address - Phone:319-354-2653
Practice Address - Fax:319-339-1364
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA36514207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA13377OtherWELLMARK BCBS
IA0727735Medicaid
IA0727735Medicaid
IAI17947Medicare PIN