Provider Demographics
NPI:1649367509
Name:THOMPSON, DODSON W (DO)
Entity type:Individual
Prefix:
First Name:DODSON
Middle Name:W
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W SHELL CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:MINONG
Mailing Address - State:WI
Mailing Address - Zip Code:54859
Mailing Address - Country:US
Mailing Address - Phone:715-466-2201
Mailing Address - Fax:715-466-2205
Practice Address - Street 1:600 W SHELL CREEK ROAD
Practice Address - Street 2:
Practice Address - City:MINONG
Practice Address - State:WI
Practice Address - Zip Code:54859
Practice Address - Country:US
Practice Address - Phone:715-466-2201
Practice Address - Fax:715-466-2205
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3663207P00000X
WI50799207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43546100Medicaid
66005-0020Medicare UPIN
WI43546100Medicaid