Provider Demographics
NPI:1316431711
Name:THOMPSON, CHRISTIN JACQUELINE (MD)
Entity type:Individual
Prefix:
First Name:CHRISTIN
Middle Name:JACQUELINE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15651 SHADOW MOUNTAIN RANCH RD
Mailing Address - Street 2:
Mailing Address - City:LARKSPUR
Mailing Address - State:CO
Mailing Address - Zip Code:80118-5628
Mailing Address - Country:US
Mailing Address - Phone:719-200-6424
Mailing Address - Fax:
Practice Address - Street 1:907 LAKE AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-2454
Practice Address - Country:US
Practice Address - Phone:719-557-5885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COTL0007843207Q00000X
CODR.0069413208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine