Provider Demographics
NPI:1003834649
Name:THOMPSON, JEANNE M (MD)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:M
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 950202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0202
Mailing Address - Country:US
Mailing Address - Phone:502-969-6552
Mailing Address - Fax:502-969-3799
Practice Address - Street 1:3 AUDUBON PLAZA DR
Practice Address - Street 2:LL2
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1319
Practice Address - Country:US
Practice Address - Phone:502-636-8095
Practice Address - Fax:502-636-8097
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01052521207R00000X
KY41076207RB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2852889000OtherPASSPORT ADVANTAGE- NORTON CMA
KY50015382OtherPASSPORT- NORTON CMA
KY000000520350OtherANTHEM- NORTON CMA
KY086789OtherSIHO- NORTON CMA
KY9740797OtherCIGNA- NORTON CMA
KYP00400038OtherRAILROARD MEDICARE - KY
IN200249650OtherMEDICAID INDIANA- NORTON CMA
KY7100008310Medicaid
KY0998862Medicare PIN
KY2852889000OtherPASSPORT ADVANTAGE- NORTON CMA