Provider Demographics
NPI:1750327466
Name:THOMPSON, HOWARD (MD)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:
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 3810
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803
Mailing Address - Country:US
Mailing Address - Phone:417-347-8590
Mailing Address - Fax:417-347-8597
Practice Address - Street 1:1532 W 32ND ST
Practice Address - Street 2:STE 302
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1607
Practice Address - Country:US
Practice Address - Phone:417-347-8590
Practice Address - Fax:417-347-8597
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO104217207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100146880BMedicaid
MO113461OtherANTHEM
OK100064420AMedicaid
MO206726812Medicaid
KS100146880BMedicaid
MO206726812Medicaid