Provider Demographics
NPI:1730176751
Name:THOMPSON, WILLIAM B JR (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:B
Last Name:THOMPSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 SW 22ND PL
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-7765
Mailing Address - Country:US
Mailing Address - Phone:352-732-5042
Mailing Address - Fax:352-732-6031
Practice Address - Street 1:2120 SW 22ND PL
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-7765
Practice Address - Country:US
Practice Address - Phone:352-732-5042
Practice Address - Fax:352-732-6031
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0039566207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL039940000Medicaid
FL101058OtherAVMED PROVIDER NUMBER
FL216584OtherHEALTHEASE/WELLCARE
FL040012995OtherRAILROAD MEDICARE #
FL42190OtherBLUE CROSS PROVIDER #
FL4544150OtherAETNA PROVIDER NUMBER
FLD62431Medicare UPIN
FL101058OtherAVMED PROVIDER NUMBER