MEDICARE: DR. JESS LEE THOMPSON III M.D.

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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	44766	AZ
2	208600000X	Surgery Physician	31236	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	:	1376515452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESS LEE THOMPSON III M.D.

Provider Business Mailing Address
First Line	:	PO BOX 10880
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86304-0880
Country	:	US
Telephone Number	:	928-759-5874
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 CHILDRENS AVE
Second Line	:	STE 2E
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-4637
Country	:	US
Telephone Number	:	405-271-5789
Fax Number	:	405-271-1643

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

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	05/29/2020

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