Individual
T JASON THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1210 W 18TH ST, STE G01, SIOUX FALLS, SD 57104-4647
(605) 328-2663
(605) 328-3760
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0721
SD
363A00000X
Physician Assistant
109464
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100350750A
—
KS
01
—
159639
ANTHEM
MO
01
—
970006660
RR MEDICARE
—
Enumeration date
07/21/2006
Last updated
11/05/2009
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