Provider Demographics
NPI:1831897404
Name:THOMPSON, ALEXANDER MARTIN (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:MARTIN
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 1:1733 CENTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61102-2422
Mailing Address - Country:US
Mailing Address - Phone:815-985-0909
Mailing Address - Fax:
Practice Address - Street 1:655 N ALVERNON WAY STE 204
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1825
Practice Address - Country:US
Practice Address - Phone:520-626-0044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-22
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR80262207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZR80262OtherARIZONA PHYSICIAN IN TRAINING PERMIT
NONEOtherNONE