Basic Information
| Provider Information | |||||||||
| NPI: | 1043296957 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3340 PLAYERS CLUB PKWY STE 350 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381258949 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012072032 | ||||||||
| FaxNumber: | 8447522164 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 BELK BLVD | ||||||||
| Address2: | |||||||||
| City: | OXFORD | ||||||||
| State: | MS | ||||||||
| PostalCode: | 38655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6622328100 | ||||||||
| FaxNumber: | 6625131496 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2005 | ||||||||
| LastUpdateDate: | 06/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 24465 | TN | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 21416 | MS | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 127556001 | 05 | AR | MEDICAID | 207821406 | 05 | MO | MEDICAID | 3077001 | 01 | TN | BLUECROSS BLUESHIELD | OTHER | 3077737 | 05 | TN | MEDICAID | 50046030 | 01 | MEDICARE RAILROAD | OTHER | 00125621 | 05 | MS | MEDICAID | 97195 | 01 | AR | BLUECROSS BLUESHIELD | OTHER |