Healthcare Provider Details

I. General information

NPI: 1598259319
Provider Name (Legal Business Name): WILLIAM CYRUS THOMPSON III DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2018
Last Update Date: 07/17/2022
Certification Date: 07/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 MAIN ST
MONROE CITY IN
47557-7356
US

IV. Provider business mailing address

1201 MAIN ST. PO BOX 6
MONROE CITY IN
47557
US

V. Phone/Fax

Practice location:
  • Phone: 812-743-5113
  • Fax: 812-743-2748
Mailing address:
  • Phone: 812-743-5113
  • Fax: 812-743-2748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02005781A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: