Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0401X | Internist - Addiction Medicine | OS14417 | FL |
NPI | 1891128732 |
---|---|
Provider Name | Dr. Ashton Pierce Thompson |
First Address | Wilton Manors, FL 33305 |
Second Address | Wilton Manors, FL 33305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2013 |
Last Update Date | 11/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OS14417 | STATE LICENSE DEPT HEALTH (01) | FL |