Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 25322 | TN |
NPI | 1982660015 |
---|---|
Provider Name | Dr. Jerome W Thompson |
First Address | Memphis, TN 38105-4625 |
Second Address | Memphis, TN 38105 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 05/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3086217 | (05) | TN |
A91772 | (02) |