MEDICARE: DR. SUSANNE PATRICIA THOMPSON DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	3291	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033111547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSANNE PATRICIA THOMPSON DO

Provider Business Mailing Address
First Line	:	PO BOX 27434
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74149-0434
Country	:	US
Telephone Number	:	918-587-5100
Fax Number	:	918-587-5102

Provider Business Practice Location Address
First Line	:	2526 W EDISON ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74127
Country	:	US
Telephone Number	:	918-587-5100
Fax Number	:	918-587-5102

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	07/31/2012

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