Healthcare Provider Details

I. General information

NPI: 1942265277
Provider Name (Legal Business Name): WILLIAM R. THOMPSON III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: W. RALEIGH THOMPSON III MD

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 11/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N ORANGE AVE SUITE 200
ORLANDO FL
32804-4603
US

IV. Provider business mailing address

2501 N ORANGE AVE SUITE 200
ORLANDO FL
32804-4603
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-7280
  • Fax: 407-303-7265
Mailing address:
  • Phone: 407-303-7280
  • Fax: 407-303-7265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME74661
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberME74661
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberME74661
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: