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General NPI Number Information
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NPI Number | 1326219387
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Entity Type | Organization
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Legal Business Name | J DEREK THOMPSON MD PA
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Dates
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Enumeration Date | 03/18/2008
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Last Update Date | 07/22/2008
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Provider Practice Location Address
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Address Line | 1210 WATERMAN WAY
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City | TAVARES
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State | FL
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Zip | 32778-5229
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Country | US
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Telephone | 352-343-8284
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Fax | 352-343-8218
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Provider Business Mailing Address
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Address Line | 1210 WATERMAN WAY
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City | TAVARES
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State | FL
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Zip | 32778-5229
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Country | US
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Telephone | 352-343-8284
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Fax | 352-343-8218
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Authorized Official
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Title or Position | OWNER
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Name | J DEREK THOMPSON
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Credential | MD
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Telephone | 352-343-8284
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | ME51022
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License Number State | FL
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