Healthcare Provider Details

I. General information

NPI: 1710312236
Provider Name (Legal Business Name): LORIE THOMPSON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2013
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5955 RAND BLVD
SARASOTA FL
34238-5160
US

IV. Provider business mailing address

5955 RAND BLVD
SARASOTA FL
34238-5160
US

V. Phone/Fax

Practice location:
  • Phone: 941-552-7508
  • Fax: 941-552-7605
Mailing address:
  • Phone: 419-552-7508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberUO3540
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS12865
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: