Healthcare Provider Details

I. General information

NPI: 1245327899
Provider Name (Legal Business Name): SUSAN J THOMPSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MOUNTAIN ST E
CAVALIER ND
58220-4015
US

IV. Provider business mailing address

301 MOUNTAIN ST E
CAVALIER ND
58220-4015
US

V. Phone/Fax

Practice location:
  • Phone: 701-265-6307
  • Fax: 701-265-6387
Mailing address:
  • Phone: 701-265-8461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number7881
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: