Provider Demographics
NPI:1780728428
Name:THOMPSON, ROBERT BRUCE (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:BRUCE
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 2489
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28151
Mailing Address - Country:US
Mailing Address - Phone:704-481-0555
Mailing Address - Fax:704-481-9169
Practice Address - Street 1:419 EARL ROAD
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150
Practice Address - Country:US
Practice Address - Phone:704-481-0555
Practice Address - Fax:704-481-9169
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC400062084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCF11007Medicare UPIN
2164645DMedicare ID - Type Unspecified