Healthcare Provider Details

I. General information

NPI: 1104906551
Provider Name (Legal Business Name): LEE ALLEN THOMPSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10421 MONTGOMERY PKWY NE
ALBUQUERQUE NM
87111
US

IV. Provider business mailing address

10421 MONTGOMERY PKWY NE
ALBUQUERQUE NM
87111
US

V. Phone/Fax

Practice location:
  • Phone: 505-298-5444
  • Fax: 505-298-0037
Mailing address:
  • Phone: 505-298-5444
  • Fax: 505-298-0037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA65677
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: