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General NPI Number Information
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NPI Number | 1114670775
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Entity Type | Individual
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Provider Name | JACOB STEPHEN THOMPSON DO
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Gender | Male
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Dates
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Enumeration Date | 02/02/2022
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 77 NEALY AVE
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City | HAMPTON
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State | VA
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Zip | 23665-2040
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Country | US
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Telephone | 757-225-2368
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Fax |
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Provider Business Mailing Address
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Address Line | 77 NEALY AVE FL 2551
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City | HAMPTON
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State | VA
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Zip | 23665-2040
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Country | US
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Telephone | 757-225-2368
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 2024016801
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2024016801
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License Number State | MO
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