Individual
ELISA J. THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
120 MEDICAL BLVD STE 103, SPRING HILL, FL 34609-0221
(352) 340-2115
(352) 340-2116
Mailing address
2675 WINKLER AVE FL 2, FORT MYERS, FL 33901-9342
(877) 856-3774
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
16013
ME
207Q00000X
Family Medicine Physician
Primary
ME125969
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
255720099
—
ME
01
—
P00245819
RAILROAD MEDICARE
ME
Enumeration date
06/15/2006
Last updated
01/16/2024
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