MEDICARE: MR. BRIAN JAMES THOMPSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	26718	CO

General Provider Information

NPI Number	:	1205980463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRIAN JAMES THOMPSON M.D.

Provider Business Mailing Address
First Line	:	5105 E COUNTY ROAD 52
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-9483
Country	:	US
Telephone Number	:	970-484-9817
Fax Number	:	970-482-6626

Provider Business Practice Location Address
First Line	:	620 S LEMAY AVE
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-3543
Country	:	US
Telephone Number	:	970-482-6620
Fax Number	:	970-482-6626

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	07/08/2007

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