MEDICARE: KEVIN 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	207Q00000X	Family Medicine Physician	ME89343	FL

General Provider Information

NPI Number	:	1942627476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN THOMPSON M.D.

Provider Business Mailing Address
First Line	:	1011 SAN RAFAEL ST
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32080-5348
Country	:	US
Telephone Number	:	904-540-5277
Fax Number	:

Provider Business Practice Location Address
First Line	:	5530-1 FLORIDA MINING BLVD. S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257
Country	:	US
Telephone Number	:	904-826-5001
Fax Number	:	904-661-0021

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

Provider Enumeration Date	:	03/21/2014
Last Update Date	:	12/09/2019

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