Provider Demographics
NPI:1982675666
Name:THOMPSON, ROBERT E
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17075 DEVONSHIRE ST
Mailing Address - Street 2:#205
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-1600
Mailing Address - Country:US
Mailing Address - Phone:818-368-3250
Mailing Address - Fax:818-363-9646
Practice Address - Street 1:17075 DEVONSHIRE ST
Practice Address - Street 2:# 205
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-1600
Practice Address - Country:US
Practice Address - Phone:818-368-3250
Practice Address - Fax:818-363-9646
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30548207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G30548Medicaid
A44462Medicare UPIN
CA00G30548Medicaid