Healthcare Provider Details

I. General information

NPI: 1871780486
Provider Name (Legal Business Name): MR. PHILLIP DON THOMPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 09/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 SW 15TH ST
OKLAHOMA CITY OK
73108-6803
US

IV. Provider business mailing address

1608 NE 9TH ST
OKLAHOMA CITY OK
73117-2808
US

V. Phone/Fax

Practice location:
  • Phone: 405-634-0508
  • Fax: 405-616-5678
Mailing address:
  • Phone: 405-414-7885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: