Provider Demographics
NPI:1992742902
Name:THOMPSON, PAUL E JR (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:E
Last Name:THOMPSON
Suffix:JR
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:PO BOX 2020
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29679-2020
Mailing Address - Country:US
Mailing Address - Phone:864-882-5933
Mailing Address - Fax:864-885-9404
Practice Address - Street 1:12 BOARDWALK PL
Practice Address - Street 2:SUITE 1A
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-2671
Practice Address - Country:US
Practice Address - Phone:264-228-5933
Practice Address - Fax:264-225-9404
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16369207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0707Medicaid
SCGP0707Medicaid