Provider Demographics
NPI:1629078423
Name:THOMPSON, PAUL BRIAN (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:BRIAN
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:93 DELANNOY AVE
Mailing Address - Street 2:UNIT 1202
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32922
Mailing Address - Country:US
Mailing Address - Phone:321-480-8315
Mailing Address - Fax:321-433-1935
Practice Address - Street 1:93 DELANNOY AVE
Practice Address - Street 2:UNIT 1202
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922
Practice Address - Country:US
Practice Address - Phone:321-480-8315
Practice Address - Fax:321-433-1935
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME48672208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250299200Medicaid
FL02136XMedicare PIN
FLD50353Medicare UPIN