Basic Information
| Provider Information | |||||||||
| NPI: | 1164515029 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMSEN | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2333 HIGHWAY 17 | ||||||||
| Address2: | |||||||||
| City: | IBERIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 654869331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5737936900 | ||||||||
| FaxNumber: | 5737936688 | ||||||||
| Practice Location | |||||||||
| Address1: | 2333 HIGHWAY 17 | ||||||||
| Address2: | |||||||||
| City: | IBERIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 654869331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5737936900 | ||||||||
| FaxNumber: | 5737936688 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 03/27/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2008037063 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.