Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 00203595 | CO |
Y | 1223G0001X | General Practice | 12013073A | IN |
Y | 213EG0000X | General Practice | 12013073A | IN |
NPI | 1003302894 |
---|---|
Provider Name | Dr. Bryan Mcguigan Thompson |
First Address | Fort Wayne, IN 46825-5720 |
Second Address | Fort Wayne, IN 46825-5720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2018 |
Last Update Date | 15/02/2021 |