MEDICARE: DR. EMMITT MICHAEL 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	207RA0401X	Addiction Medicine (Internal Medicine) Physician	53103	AZ
2	207RB0002X	Obesity Medicine (Internal Medicine) Physician	148662	FL
3	207NS0135X	Procedural Dermatology Physician	148662	FL
4	207RS0012X	Sleep Medicine (Internal Medicine) Physician	ME148662	FL
5	2083A0300X	Addiction Medicine (Preventive Medicine) Physician	ME148662	FL
6	2083B0002X	Obesity Medicine (Preventive Medicine) Physician	ME148662	FL
7	208D00000X	General Practice Physician	53103	AZ
8	207R00000X	Internal Medicine Physician	ME148662	FL

General Provider Information

NPI Number	:	1760890131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMMITT MICHAEL THOMPSON M.D.

Provider Business Mailing Address
First Line	:	822 WEST EARLL DRIVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013
Country	:	US
Telephone Number	:	602-524-7684
Fax Number	:

Provider Business Practice Location Address
First Line	:	13569 PANAMA CITY BEACH PKWY
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32407-2847
Country	:	US
Telephone Number	:	850-238-8563
Fax Number	:

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

Provider Enumeration Date	:	07/29/2014
Last Update Date	:	10/04/2023

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