Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 20833 | MN |
Y | 208600000X | Surgeon | 20833 | MN |
NPI | 1023040219 |
---|---|
Provider Name | Jerome I Thompson |
First Address | Bemidji, MN 56601-5112 |
Second Address | Fargo, ND 58122-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 24/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D80292 | (02) |