MEDICARE: BRUCE D THOMPSON MD

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	208D00000X	General Practice Physician	24945	OK

General Provider Information

NPI Number	:	1114027927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE D THOMPSON MD

Provider Business Mailing Address
First Line	:	3555 NW 58TH ST
Second Line	:	SUITE 900
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-4707
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4510 NW 39TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73122-2503
Country	:	US
Telephone Number	:	405-495-5841
Fax Number	:

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

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	07/08/2007

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Directions to “ BRUCE D THOMPSON MD” Practice Location

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