Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DN9739 | FL |
NPI | 1003807603 |
---|---|
Provider Name | Dr. Geoffrey Allen Thompson |
First Address | Libertyville, IL 60048-1364 |
Second Address | Great Lakes, IL 60088-5259 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2005 |
Last Update Date | 08/07/2007 |