MEDICARE: DR. PAUL BRIAN THOMPSON 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	208600000X	Surgery Physician	ME48672	FL

General Provider Information

NPI Number	:	1629078423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL BRIAN THOMPSON M.D.

Provider Business Mailing Address
First Line	:	93 DELANNOY AVE
Second Line	:	UNIT 1202
City	:	COCOA
State	:	FL
Zip	:	32922
Country	:	US
Telephone Number	:	321-480-8315
Fax Number	:	321-433-1935

Provider Business Practice Location Address
First Line	:	93 DELANNOY AVE
Second Line	:	UNIT 1202
City	:	COCOA
State	:	FL
Zip	:	32922
Country	:	US
Telephone Number	:	321-480-8315
Fax Number	:	321-433-1935

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	10/08/2024

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