Provider Demographics
NPI:1770529471
Name:THOMPSON, ROBERT B (M D)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:B
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 N. MIDWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110
Mailing Address - Country:US
Mailing Address - Phone:405-737-3491
Mailing Address - Fax:405-737-5956
Practice Address - Street 1:215 N MIDWEST BLVD
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-4320
Practice Address - Country:US
Practice Address - Phone:405-737-3491
Practice Address - Fax:405-737-5956
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10027207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK141721400OtherDEPT OF LABOR
OK100128800BMedicaid
OK200039156OtherRAILROAD MEDICARE
OK4351788OtherAETNA
OK620198OtherTRIGON
OK68G04OtherEMPIRE BCBS
OKD42883Medicare UPIN
OK238710801Medicare PIN