Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 68674 | CT |
NPI | 1073924197 |
---|---|
Provider Name | Patrick Clyne Thompson |
First Address | North Haven, CT 06473-6103 |
Second Address | Palo Alto, CA 94305-5642 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2014 |
Last Update Date | 02/07/2021 |