Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 34.014544 | OH |
NPI | 1083145668 |
---|---|
Provider Name | Douglas Michael Thompson |
First Address | Cincinnati, OH 45212-3589 |
Second Address | West Chester, OH 45069-5802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2017 |
Last Update Date | 14/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2565399 | (05) | OH |