Provider Demographics
NPI:1255393450
Name:THOMPSON, RODNEY L (MD)
Entity type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:L
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:PO BOX 1010
Mailing Address - Street 2:112 COLUMBIA ST.
Mailing Address - City:SUMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98295-1010
Mailing Address - Country:US
Mailing Address - Phone:360-988-9404
Mailing Address - Fax:360-988-9409
Practice Address - Street 1:112 COLUMBIA ST.
Practice Address - Street 2:POB 1010
Practice Address - City:SUMAS
Practice Address - State:WA
Practice Address - Zip Code:98295-1010
Practice Address - Country:US
Practice Address - Phone:360-988-9404
Practice Address - Fax:360-988-9409
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00039892207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8294498Medicaid
WAG35501Medicare UPIN
WAG8852833Medicare PIN