Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 54234 | TN |
N | 111NI0900X | Internist | 54234 | TN |
Y | 207R00000X | Internist | MD60215612 | WA |
Y | 111NI0900X | Internist | MD60215612 | WA |
NPI | 1003076233 |
---|---|
Provider Name | Jeffrey C Thompson |
First Address | Renton, WA 98058-2028 |
Second Address | Renton, WA 98055-5714 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2008 |
Last Update Date | 27/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0278233 | L&I (01) | WA |