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General NPI Number Information
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NPI Number | 1265585731
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Entity Type | Individual
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Provider Name | ELIOT LLOYD THOMPSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 05/26/2016
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Provider Practice Location Address
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Address Line | 6400 DUTCHMANS PKWY SUITE 15
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City | LOUISVILLE
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State | KY
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Zip | 40205-3340
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Country | US
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Telephone | 502-895-0524
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Fax | 502-897-5798
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Provider Business Mailing Address
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Address Line | PO BOX 950293
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City | LOUISVILLE
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State | KY
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Zip | 40295-0293
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Country | US
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Telephone | 502-895-0524
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Fax | 502-897-5798
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 29736
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License Number State | KY
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