Provider Demographics
NPI:1205810785
Name:THOMPSON, ROBERT JORDAN (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JORDAN
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 1:945 BETHESDA DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-0801
Mailing Address - Country:US
Mailing Address - Phone:740-453-0680
Mailing Address - Fax:740-453-5158
Practice Address - Street 1:945 BETHESDA DR
Practice Address - Street 2:SUITE 230
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-0801
Practice Address - Country:US
Practice Address - Phone:740-453-0680
Practice Address - Fax:740-453-5158
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA350390442084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000117692OtherBLUE CROSS PROVIDER
OH0308223Medicaid
OH0308223Medicaid
OHTH0421703Medicare PIN