Provider Demographics
NPI:1427256619
Name:THOMPSON, CARL ALLEN (DO)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:ALLEN
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:530 N MONTE VISTA ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-4675
Mailing Address - Country:US
Mailing Address - Phone:580-436-7101
Mailing Address - Fax:580-436-4447
Practice Address - Street 1:1011 14TH AVE NW
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1828
Practice Address - Country:US
Practice Address - Phone:580-220-6658
Practice Address - Fax:580-220-6673
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK4563207P00000X
IL036.168288207P00000X
WI2882-321207P00000X
NY326461207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200115280AMedicaid
OKOKA100491Medicare PIN