Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 30465 | IA |
NPI | 1003892936 |
---|---|
Provider Name | Scott Alan Thompson |
First Address | West Des Moines, IA 50266-6720 |
Second Address | West Des Moines, IA 50266-6720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2005 |
Last Update Date | 03/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
050085562 | RAILROAD MEDICARE # (01) | IA |
1123059 | (05) | IA |
18738 | MIDLANDS PROVIDER # (01) | IA |
30465 | TRICARE PROVIDER # (01) | IA |
43973 | BLUE SHIELD PROVIDER # (01) | IA |
G07093 | (02) | IA |
IA01A1 | JOHN DEERE PROVIDER # (01) | IA |