Healthcare Provider Details

I. General information

NPI: 1912901752
Provider Name (Legal Business Name): ROBERT L THOMPSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 10/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13328 SHELBYVILLE RD
LOUISVILLE KY
40223
US

IV. Provider business mailing address

PO BOX 43905
LOUISVILLE KY
40253-0905
US

V. Phone/Fax

Practice location:
  • Phone: 502-583-4700
  • Fax: 502-583-8434
Mailing address:
  • Phone: 502-583-4700
  • Fax: 502-583-8434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number27076
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number091290A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: