Provider Demographics
NPI:1992870471
Name:THOMSON, GREGORY JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JOHN
Last Name:THOMSON
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 1:220 W PEARL ST UNIT 4313
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-5473
Mailing Address - Country:US
Mailing Address - Phone:503-913-5548
Mailing Address - Fax:949-561-4107
Practice Address - Street 1:555 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-8640
Practice Address - Country:US
Practice Address - Phone:833-437-4863
Practice Address - Fax:949-561-4107
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2020-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKMEDS7811207XX0801X
WY12812A207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR262452Medicaid
WA158337OtherWASH L & I
WA1114511Medicaid
WA1114511Medicaid
109774Medicare PIN