Provider Demographics
NPI:1306121108
Name:THOMPSON, TRUMAN LORENZO (ARDMS)
Entity type:Individual
Prefix:MR
First Name:TRUMAN
Middle Name:LORENZO
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:ARDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10217 MADISON GROVE AVENUE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-5266
Mailing Address - Country:US
Mailing Address - Phone:702-789-8096
Mailing Address - Fax:702-380-8187
Practice Address - Street 1:10217 MADISON GROVE AVENUE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89166-5266
Practice Address - Country:US
Practice Address - Phone:702-789-8096
Practice Address - Fax:702-380-8187
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZE0600X, 247100000X, 2471C3401X, 2471V0106X, 2472E0500X, 246Z00000X
MD924302471S1302X, 2471V0105X, 246XS1301X
MN2837522471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
No2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography
No2471V0106XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular-Interventional Technology
No2472E0500XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherEEG
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
No246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography
No2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other