Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 25875-020 | WI |
NPI | 1003890690 |
---|---|
Provider Name | Dr. Stephen R Thompson |
First Address | Brookfield, WI 53005-4266 |
Second Address | Milwaukee, WI 53211-2906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2005 |
Last Update Date | 15/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30592100 | (05) | WI |
B57131 | (02) | WI |
P00612365 | RAIL ROAD MEDICARE (01) |