Healthcare Provider Details

I. General information

NPI: 1164878237
Provider Name (Legal Business Name): SAMUEL FRANKLIN THOMPSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2016
Last Update Date: 08/30/2022
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S KEENE ST
COLUMBIA MO
65201-7199
US

IV. Provider business mailing address

1 S KEENE ST
COLUMBIA MO
65201-7199
US

V. Phone/Fax

Practice location:
  • Phone: 573-443-2402
  • Fax:
Mailing address:
  • Phone: 573-443-2402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number32382
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number2022011296
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: