Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | ME88199 | FL |
NPI | 1003893389 |
---|---|
Provider Name | Dr. Paul David Thompson |
First Address | Maitland, FL 32751-7420 |
Second Address | Orlando, FL 32803-1248 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2005 |
Last Update Date | 28/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
267611700 | (05) | FL |
81103 | BCBS (01) | FL |
H70714 | (02) | FL |