Healthcare Provider Details

I. General information

NPI: 1003834649
Provider Name (Legal Business Name): JEANNE M THOMPSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 AUDUBON PLAZA DR LL2
LOUISVILLE KY
40217-1319
US

IV. Provider business mailing address

PO BOX 950202
LOUISVILLE KY
40295-0202
US

V. Phone/Fax

Practice location:
  • Phone: 502-636-8095
  • Fax: 502-636-8097
Mailing address:
  • Phone: 502-969-6552
  • Fax: 502-969-3799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01052521
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number41076
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: