Healthcare Provider Details

I. General information

NPI: 1770757429
Provider Name (Legal Business Name): CHRISTOPHER JOHN THOMPSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 CENTRACARE CIR CENTRACARE CLINIC HEALTH PLAZA/FAMILY MEDICINE
SAINT CLOUD MN
56303-5000
US

IV. Provider business mailing address

1406 6TH AVE N ST CLOUD HOSPITAL
SAINT CLOUD MN
56303-1900
US

V. Phone/Fax

Practice location:
  • Phone: 320-229-4917
  • Fax: 320-229-5180
Mailing address:
  • Phone: 320-251-2700
  • Fax: 320-656-7115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number50996
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: