Basic Information
| Provider Information | |||||||||
| NPI: | 1528041118 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | VICTOR | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 345 MAXWELL AVE | ||||||||
| Address2: | |||||||||
| City: | BOULDER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 803043972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3035445777 | ||||||||
| FaxNumber: | 3035445775 | ||||||||
| Practice Location | |||||||||
| Address1: | 6685 GUNPARK DR EAST | ||||||||
| Address2: | STE 110 | ||||||||
| City: | BOULDER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3035303062 | ||||||||
| FaxNumber: | 3035305474 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2005 | ||||||||
| LastUpdateDate: | 03/04/2008 | ||||||||
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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 | 22823 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01228238 | 05 | CO | MEDICAID |