Healthcare Provider Details

I. General information

NPI: 1265266563
Provider Name (Legal Business Name): WILLIAM ROBERT THOMPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2024
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 H ST
EUREKA CA
95501-1022
US

IV. Provider business mailing address

404 H ST
EUREKA CA
95501-1022
US

V. Phone/Fax

Practice location:
  • Phone: 707-267-9320
  • Fax: 707-268-8353
Mailing address:
  • Phone: 707-382-9628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: