Healthcare Provider Details

I. General information

NPI: 1144236555
Provider Name (Legal Business Name): MATTHEW C THOMPSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5155 55TH ST NW
ROCHESTER MN
55901-3855
US

IV. Provider business mailing address

5155 55TH ST NW
ROCHESTER MN
55901-3855
US

V. Phone/Fax

Practice location:
  • Phone: 507-535-1977
  • Fax:
Mailing address:
  • Phone: 507-535-1977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number48777
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: