Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 9757995-1205 | UT |
Y | 2080P0207X | Pediatric Hematology-Oncologist | 9757995-1205 | UT |
NPI | 1033409016 |
---|---|
Provider Name | Mr. William Christopher Thomsen JR. |
First Address | Salem, VA 24153-4616 |
Second Address | Salem, VA 24153-4616 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2011 |
Last Update Date | 17/12/2021 |