Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | G54654 | CA |
NPI | 1013905496 |
---|---|
Provider Name | Steven Allen Thompson |
First Address | Truckee, CA 96161-4821 |
Second Address | Truckee, CA 96161-4821 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2005 |
Last Update Date | 10/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A52764 | (02) |