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Individual
GLEN THOMPSON III
Active
Individual
GLEN THOMPSON III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CSA
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
2222
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000493588
ANTHEM
KY
Enumeration date
05/01/2007
Last updated
07/08/2007
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