Healthcare Provider Details

I. General information

NPI: 1124125018
Provider Name (Legal Business Name): MATTHEW A THOMPSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 W 8TH AVE
SPOKANE WA
99204-2505
US

IV. Provider business mailing address

319 W 8TH AVE
SPOKANE WA
99204-2505
US

V. Phone/Fax

Practice location:
  • Phone: 509-448-7337
  • Fax: 509-448-4750
Mailing address:
  • Phone: 509-448-7337
  • Fax: 509-448-4750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00043480
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: