Provider Demographics
NPI:1841246022
Name:THOMPSON, KEITH A (MD)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:A
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 1:4145 CARMICHAEL ROAD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2801
Mailing Address - Country:US
Mailing Address - Phone:334-273-7000
Mailing Address - Fax:334-273-2386
Practice Address - Street 1:4145 CARMICHAEL ROAD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2801
Practice Address - Country:US
Practice Address - Phone:334-273-7000
Practice Address - Fax:334-273-2228
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15808207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0000264456Medicaid
AL009935365Medicaid
AL009935367Medicaid
AL009935367Medicaid
4248810002Medicare NSC
000026456Medicare PIN
E41700Medicare UPIN
AL0000264456Medicaid
4248810003Medicare NSC