Provider Demographics
NPI:1265590293
Name:THOMPSON, ROBERT G (MD)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:G
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 1:188 W MARYSDALE AVE
Mailing Address - Street 2:
Mailing Address - City:SALDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669
Mailing Address - Country:US
Mailing Address - Phone:907-260-6914
Mailing Address - Fax:907-260-6924
Practice Address - Street 1:188 W MARYSDALE AVE
Practice Address - Street 2:
Practice Address - City:SALDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669
Practice Address - Country:US
Practice Address - Phone:907-260-6914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2047207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK9956Medicaid
AK9956Medicaid