Healthcare Provider Details

I. General information

NPI: 1457600496
Provider Name (Legal Business Name): NATHAN JAMES THOMPSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPARTMENT OF PATHOLOGY BMSB 335 915 CAMINO
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

DEPARTMENT OF PATHOLOGY MSC08 4640 BMSB ROOM 335 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-4814
  • Fax: 505-272-8084
Mailing address:
  • Phone: 505-272-4814
  • Fax: 505-272-8084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number3709
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberFT5124843
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number05-37875
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: