Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 24560 | AL |
NPI | 1063479905 |
---|---|
Provider Name | Lee Walton Thompson |
First Address | Mobile, AL 36607-3520 |
Second Address | Mobile, AL 36607-3520 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 09/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00126562 | MISSISSIPPI MEDICAID (01) | MS |
009986440 | (05) | AL |
051507487 | BCBS OF ALABAMA (01) | AL |
H37904 | (02) | AL |