Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | G60675 | CA |
N | 2081P2900X | Pain Medicine | G60675 | CA |
NPI | 1043308471 |
---|---|
Provider Name | Dr. Blake R Thompson |
First Address | San Diego, CA 92108-5680 |
Second Address | San Diego, CA 92108-5680 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 01/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E67056 | (02) |