Individual
MS. GWYNETH SMITH THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
415 N 9TH ST, SUITE 6W100, SPRINGFIELD, IL 62702-5303
(217) 545-5117
(217) 545-7958
Mailing address
PO BOX 19639, SPRINGFIELD, IL 62794-9639
(217) 545-7578
(217) 545-1884
Taxonomy
Speciality
Code
Description
License number
State
207VM0101X
Maternal & Fetal Medicine Physician
Primary
036113866
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036113866
—
IL
Enumeration date
04/03/2007
Last updated
12/07/2020
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