Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | DO1240 | TN |
NPI | 1326151655 |
---|---|
Provider Name | Dr. Dennis A. Thompson |
First Address | Cleveland, TN 37312-3699 |
Second Address | Cleveland, TN 37312-3699 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 06/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H03375 | (02) | TN |