Healthcare Provider Details

I. General information

NPI: 1720770415
Provider Name (Legal Business Name): BRIAN SCOTT THOMPSON JR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10280 N 91ST AVE
PEORIA AZ
85345-6461
US

IV. Provider business mailing address

10280 N 91ST AVE
PEORIA AZ
85345-6461
US

V. Phone/Fax

Practice location:
  • Phone: 520-526-4396
  • Fax:
Mailing address:
  • Phone: 520-526-4396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR3975
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: