Provider Demographics
NPI:1104322080
Name:THOMPSON, RICHARD AUSTIN (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:AUSTIN
Last Name:THOMPSON
Suffix:
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 1:700 6TH ST S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4815
Mailing Address - Country:US
Mailing Address - Phone:727-893-6116
Mailing Address - Fax:727-553-7340
Practice Address - Street 1:7550 43RD ST N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-3601
Practice Address - Country:US
Practice Address - Phone:727-824-8181
Practice Address - Fax:727-471-7892
Is Sole Proprietor?:No
Enumeration Date:2018-04-01
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME142214207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine