Provider Demographics
NPI:1780667105
Name:THOMPSON, LEIF (MD)
Entity type:Individual
Prefix:DR
First Name:LEIF
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 1:1717 W COWLES ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-5926
Mailing Address - Country:US
Mailing Address - Phone:907-451-6682
Mailing Address - Fax:907-459-3811
Practice Address - Street 1:1408 19TH AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5903
Practice Address - Country:US
Practice Address - Phone:907-451-6682
Practice Address - Fax:907-459-3811
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4935207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1014545Medicaid
AK1014545Medicaid
AK8HI790Medicare Oscar/Certification
8EA005Medicare ID - Type Unspecified
8EA007Medicare ID - Type Unspecified
8EA015Medicare ID - Type Unspecified
H97342Medicare UPIN
8EA002Medicare ID - Type Unspecified
8EA003Medicare ID - Type Unspecified
8EA004Medicare ID - Type Unspecified
8EA010Medicare ID - Type Unspecified
8EA013Medicare ID - Type Unspecified
8EA006Medicare ID - Type Unspecified
8EA008Medicare ID - Type Unspecified
AKM046163Medicaid
8EA011Medicare ID - Type Unspecified
8EA016Medicare ID - Type Unspecified
8EA014Medicare ID - Type Unspecified
8EA017Medicare ID - Type Unspecified
8EA012Medicare ID - Type Unspecified