Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 5553 | NV |
NPI | 1003930025 |
---|---|
Provider Name | Douglas Franklin Thompson |
First Address | Boulder City, NV 89005-3611 |
Second Address | Boulder City, NV 89005-2213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
20-02116 | (05) | NV |
C96803 | (02) | NV |