Healthcare Provider Details

I. General information

NPI: 1598175655
Provider Name (Legal Business Name): JUSTIN MICHAEL THOMPSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 WELCH RD
PALO ALTO CA
94304-1601
US

IV. Provider business mailing address

725 WELCH RD
PALO ALTO CA
94304-1601
US

V. Phone/Fax

Practice location:
  • Phone: 650-497-8000
  • Fax: 925-935-1070
Mailing address:
  • Phone: 650-497-8000
  • Fax: 925-935-1070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA138995
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: