Healthcare Provider Details

I. General information

NPI: 1376595686
Provider Name (Legal Business Name): LEONARD JAMES THOMPSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 PRINGLE WAY SUITE 904
RENO NV
89502-1464
US

IV. Provider business mailing address

75 PRINGLE WAY SUITE 904
RENO NV
89502-1464
US

V. Phone/Fax

Practice location:
  • Phone: 775-324-7337
  • Fax: 775-324-7352
Mailing address:
  • Phone: 775-324-7337
  • Fax: 775-324-7352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number305
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: