Healthcare Provider Details

I. General information

NPI: 1801819602
Provider Name (Legal Business Name): ROBERT BERNARD THOMPSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 11/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 N EAGLE CREEK DR SUITE 400
LEXINGTON KY
40509-2121
US

IV. Provider business mailing address

160 N EAGLE CREEK DR SUITE 400
LEXINGTON KY
40509-2121
US

V. Phone/Fax

Practice location:
  • Phone: 859-258-5220
  • Fax: 859-258-5405
Mailing address:
  • Phone: 859-258-5220
  • Fax: 859-258-5405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number16028
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: