Healthcare Provider Details

I. General information

NPI: 1023005535
Provider Name (Legal Business Name): JEFFREY D THOMPSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1129 HALE RD
MEMPHIS TN
38116-6373
US

IV. Provider business mailing address

1129 HALE RD
MEMPHIS TN
38116-6373
US

V. Phone/Fax

Practice location:
  • Phone: 901-396-0390
  • Fax: 901-396-3728
Mailing address:
  • Phone: 901-396-0390
  • Fax: 901-396-3728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD35723
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD18396
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: