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General NPI Number Information
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NPI Number | 1396980165
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Entity Type | Organization
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Legal Business Name | RENEE E THOMPSON
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Dates
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Enumeration Date | 12/09/2008
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Last Update Date | 12/09/2008
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Provider Practice Location Address
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Address Line | 4201 MARLA DR NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-1937
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Country | US
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Telephone | 505-401-2945
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Fax |
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Provider Business Mailing Address
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Address Line | 4201 MARLA DR NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-1937
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Country | US
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Telephone | 505-401-2945
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Fax |
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Authorized Official
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Title or Position | SOLE PRIORETOR
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Name | RENEE E THOMPSON
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Credential | MD
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Telephone | 505-401-2945
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 2006-0100
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License Number State | NM
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