Healthcare Provider Details

I. General information

NPI: 1891098505
Provider Name (Legal Business Name): DAVID CARL THOMPSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2010
Last Update Date: 04/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2175 ROSALINE AVE
REDDING CA
96001-2549
US

IV. Provider business mailing address

1028 RIVER RIDGE DR
REDDING CA
96003-5354
US

V. Phone/Fax

Practice location:
  • Phone: 530-225-6000
  • Fax: 530-229-3703
Mailing address:
  • Phone: 530-605-4295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG28583
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: