Provider Demographics
NPI:1265864862
Name:THOMSON, NATHANIEL (DO)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:
Last Name:THOMSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:234 E GRAY ST
Mailing Address - Street 2:STE 850
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1901
Mailing Address - Country:US
Mailing Address - Phone:314-362-2978
Mailing Address - Fax:573-884-8524
Practice Address - Street 1:200 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1831
Practice Address - Country:US
Practice Address - Phone:502-585-1735
Practice Address - Fax:502-526-5489
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY045182085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty