Provider Demographics
NPI:1386627255
Name:THOMPSON, JEFFERY DEAN (PA C)
Entity type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:DEAN
Last Name:THOMPSON
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Gender:M
Credentials:PA C
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Mailing Address - Street 1:5901 SUN BLVD
Mailing Address - Street 2:SUITE 113
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33715-1166
Mailing Address - Country:US
Mailing Address - Phone:727-867-7910
Mailing Address - Fax:727-867-6379
Practice Address - Street 1:5901 SUN BLVD
Practice Address - Street 2:SUITE 113
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33715-1166
Practice Address - Country:US
Practice Address - Phone:727-867-7910
Practice Address - Fax:727-867-6379
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2013-09-26
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Provider Licenses
StateLicense IDTaxonomies
PA2396363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291360700Medicaid