Provider Demographics
NPI:1801819602
Name:THOMPSON, ROBERT BERNARD (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:BERNARD
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 1:160 N EAGLE CREEK DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2121
Mailing Address - Country:US
Mailing Address - Phone:859-258-5220
Mailing Address - Fax:859-258-5405
Practice Address - Street 1:160 N EAGLE CREEK DR
Practice Address - Street 2:SUITE 400
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2121
Practice Address - Country:US
Practice Address - Phone:859-258-5220
Practice Address - Fax:859-258-5405
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16028207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64160286Medicaid
KYASC1019OtherMEDICARE ASC GROUP
KY37903705OtherMEDICAID LAB GROUP
KYCB5773OtherRR MEDICARE GROUP #
KY36000818OtherMEDICAID ASC GROUP
KY4000501OtherMEDICARE LAB GROUP
KY37903705OtherMEDICAID LAB GROUP
KYCB5773OtherRR MEDICARE GROUP #