Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | ME43537 | FL |
NPI | 1083610794 |
---|---|
Provider Name | Paul Allen Thompson |
First Address | Orlando, FL 32801-1211 |
Second Address | Orlando, FL 32801-1211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2005 |
Last Update Date | 12/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
069874100 | (05) | FL |
D62538 | (02) |