Healthcare Provider Details

I. General information

NPI: 1194792275
Provider Name (Legal Business Name): ROBERT THOMPSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 09/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 PARALLEL PKWY
KANSAS CITY KS
66112-1510
US

IV. Provider business mailing address

9201 PARALLEL PKWY
KANSAS CITY KS
66112-1510
US

V. Phone/Fax

Practice location:
  • Phone: 913-334-4110
  • Fax:
Mailing address:
  • Phone: 913-334-4110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberR9A02
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberR9A02
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number04-19891
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: