Basic Information
| Provider Information | |||||||||
| NPI: | 1043282213 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | FREDERICK | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 314 ROGOSIN DR | ||||||||
| Address2: | |||||||||
| City: | ELIZABETHTON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376432904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234336630 | ||||||||
| FaxNumber: | 4232328574 | ||||||||
| Practice Location | |||||||||
| Address1: | 314 ROGOSIN DR | ||||||||
| Address2: | |||||||||
| City: | ELIZABETHTON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376432904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234336630 | ||||||||
| FaxNumber: | 4232328574 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2006 | ||||||||
| LastUpdateDate: | 09/01/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0101245618 | VA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 68532-20 | WI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | K2605 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 46619 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.