Healthcare Provider Details

I. General information

NPI: 1831110766
Provider Name (Legal Business Name): GEORGE THOMPSON JR. M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 09/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 W REDONDO BEACH BLVD SUITE 311
GARDENA CA
90247-3586
US

IV. Provider business mailing address

1141 W REDONDO BEACH BLVD SUITE 311
GARDENA CA
90247-3586
US

V. Phone/Fax

Practice location:
  • Phone: 310-327-5552
  • Fax: 310-324-0693
Mailing address:
  • Phone: 310-327-5552
  • Fax: 310-324-0693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberC27063
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number05D0547779
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number05D0717956
License Number StateCA

VIII. Authorized Official

Name: DR. GEORGE THOMPSON JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-327-5552