Basic Information
| Provider Information | |||||||||
| NPI: | 1396725255 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | WILLIAM | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 121 N CEDAR CREST BLVD | ||||||||
| Address2: | SUITE F | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181044664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104330246 | ||||||||
| FaxNumber: | 6104330248 | ||||||||
| Practice Location | |||||||||
| Address1: | 121 N CEDAR CREST BLVD | ||||||||
| Address2: | SUITE F | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181044664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104330246 | ||||||||
| FaxNumber: | 6104330248 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2006 | ||||||||
| LastUpdateDate: | 08/12/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD-014786-E | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 50032026 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 104562 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | P00087174 | 01 | PALMETTO GBA | OTHER |