Healthcare Provider Details

I. General information

NPI: 1063479905
Provider Name (Legal Business Name): LEE WALTON THOMPSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 02/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 MOBILE INFIRMARY CIR SUITE 305
MOBILE AL
36607-3520
US

IV. Provider business mailing address

3 MOBILE INFIRMARY CIR SUITE 305
MOBILE AL
36607-3520
US

V. Phone/Fax

Practice location:
  • Phone: 251-433-5557
  • Fax: 251-433-5558
Mailing address:
  • Phone: 251-433-5557
  • Fax: 251-433-5558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number24560
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: