Healthcare Provider Details

I. General information

NPI: 1760880223
Provider Name (Legal Business Name): JEFFREY THOMPSON MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2014
Last Update Date: 12/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 STATION WAY STE D
ARROYO GRANDE CA
93420-3359
US

IV. Provider business mailing address

260 STATION WAY STE D
ARROYO GRANDE CA
93420-3359
US

V. Phone/Fax

Practice location:
  • Phone: 805-473-2828
  • Fax: 805-473-0149
Mailing address:
  • Phone: 805-473-2828
  • Fax: 805-473-0149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG49798
License Number StateCA

VIII. Authorized Official

Name: BARBARA M LANDIS
Title or Position: MANAGER
Credential:
Phone: 805-547-1255