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General NPI Number Information
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NPI Number | 1689781791
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Entity Type | Individual
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Provider Name | TIMOTHY J THOMPSON MD
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Gender | Male
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Dates
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Enumeration Date | 08/24/2006
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | N2950 STATE ROAD 67
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City | LAKE GENEVA
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State | WI
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Zip | 53147-2655
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Country | US
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Telephone | 262-245-0535
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Fax | 262-245-2248
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Provider Business Mailing Address
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Address Line | 620 NW 11TH ST STE M201
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City | HERMISTON
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State | OR
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Zip | 97838-6941
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Country | US
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Telephone | 541-289-4118
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Fax | 541-667-3484
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD195582
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License Number State | OR
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