Provider Demographics
NPI:1912901752
Name:THOMPSON, ROBERT L (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
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 43905
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40253-0905
Mailing Address - Country:US
Mailing Address - Phone:502-583-4700
Mailing Address - Fax:502-583-8434
Practice Address - Street 1:13328 SHELBYVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223
Practice Address - Country:US
Practice Address - Phone:502-583-4700
Practice Address - Fax:502-583-8434
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY27076208100000X
IN091290A208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP02022282OtherMD2U KY- RAILROAD
IN200024040Medicaid
KYCI4364OtherKY MEDICARE RR GROUP #
KY000001169938OtherNP SERV KY- ANTHEM BCBS
KY1558953OtherMD2U KY- WELLLCARE
KY000001151932OtherMD2U KY- ANTHEM BCBS
KY7100505590Medicaid
KY25009894OtherMEDICARE RAILROAD
INCH6974OtherIN MEDICARE RR GROUP #
10806556OtherCAQH
KY64270762Medicaid