Provider Demographics
NPI:1154384162
Name:THOMPSON, CARL J (PA-C)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:J
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 N SCOTTSDALE RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-5648
Mailing Address - Country:US
Mailing Address - Phone:480-424-7228
Mailing Address - Fax:480-424-7317
Practice Address - Street 1:3501 N SCOTTSDALE RD
Practice Address - Street 2:SUITE 320
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5648
Practice Address - Country:US
Practice Address - Phone:480-424-7228
Practice Address - Fax:480-424-7317
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3295363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3295OtherLICENSE
Q56096Medicare UPIN
106485Medicare ID - Type Unspecified