Healthcare Provider Details

I. General information

NPI: 1891673745
Provider Name (Legal Business Name): JOHN THOMPSON PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12631 E 17TH AVE STE C307
AURORA CO
80045-2527
US

IV. Provider business mailing address

6793 W 98TH CIR
WESTMINSTER CO
80021-5418
US

V. Phone/Fax

Practice location:
  • Phone: 850-264-2215
  • Fax:
Mailing address:
  • Phone: 850-264-2215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberNA
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: