Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | DN14670 | FL |
N | 1223S0112X | Oral and Maxillofacial Surgeon | DN14670 | FL |
NPI | 1255302105 |
---|---|
Provider Name | Dr. Travis Thompson |
First Address | Jupiter, FL 33458 |
Second Address | Jupiter, FL 33458 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U86458 | (02) | FL |