Provider Demographics
NPI:1427076280
Name:THOMPSON, JAMES WILLARD (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:WILLARD
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 1:2301 S LAMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5373
Mailing Address - Country:US
Mailing Address - Phone:662-232-8568
Mailing Address - Fax:662-513-1450
Practice Address - Street 1:2301 S LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5373
Practice Address - Country:US
Practice Address - Phone:662-232-8568
Practice Address - Fax:662-513-1450
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19181207R00000X
GA015896207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08108824Medicaid
MS08108824Medicaid
P00289931Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MS110001949Medicare PIN