Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | ME 72049 | FL |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | ME72049 | FL |
NPI | 1306916580 |
---|---|
Provider Name | Jason R Thompson |
First Address | Jacksonville, FL 32216 |
Second Address | Jacksonville, FL 32216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 07/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
261828100 | (05) | FL |
G 40733 | (02) |