Healthcare Provider Details

I. General information

NPI: 1497747646
Provider Name (Legal Business Name): BARRY V THOMPSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 04/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 E 3RD AVE
CROSSETT AR
71635-2915
US

IV. Provider business mailing address

103 E 3RD AVE
CROSSETT AR
71635-2915
US

V. Phone/Fax

Practice location:
  • Phone: 870-364-5746
  • Fax: 870-364-5745
Mailing address:
  • Phone: 870-364-5746
  • Fax: 870-364-5745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR2641
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: