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General NPI Number Information
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NPI Number | 1487646030
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Entity Type | Individual
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Provider Name | MARK EDMUND THOMPSON D.O.
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Gender | Male
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Dates
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Enumeration Date | 08/19/2005
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 4520 W US HIGHWAY 90
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City | LAKE CITY
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State | FL
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Zip | 32055-8341
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Country | US
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Telephone | 352-755-0601
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Fax | 352-755-0602
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Provider Business Mailing Address
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Address Line | 104 WOODMONT BLVD STE 500
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City | NASHVILLE
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State | TN
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Zip | 37205-2245
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Country | US
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Telephone | 559-475-4151
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Fax | 559-421-7004
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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 | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | OS10194
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2085R0203X
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Taxonomy Name | Therapeutic Radiology Physician
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License Number | OS10194
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License Number State | FL
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