Healthcare Provider Details

I. General information

NPI: 1174563084
Provider Name (Legal Business Name): GEORGE R THOMPSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 09/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 W MAIN ST
WHITE SULPHUR SPRINGS WV
24986-2414
US

IV. Provider business mailing address

320 W MAIN ST
WHITE SULPHUR SPRINGS WV
24986-2414
US

V. Phone/Fax

Practice location:
  • Phone: 304-536-4870
  • Fax: 304-536-8010
Mailing address:
  • Phone: 304-536-4870
  • Fax: 304-536-1664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number14406
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: