Individual
MARK EDMUND THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
4520 W US HIGHWAY 90, LAKE CITY, FL 32055-8341
(352) 755-0601
(352) 755-0602
Mailing address
104 WOODMONT BLVD STE 500, NASHVILLE, TN 37205-2245
(559) 475-4151
(559) 421-7004
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
OS10194
FL
2085R0203X
Therapeutic Radiology Physician
Primary
OS10194
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02484
BLUE CROSS BLUE SHIELD
FL
05
—
0825156
—
OH
05
—
279300800
—
FL
01
—
310302
AVMED
FL
01
—
PTAN AG644E
LINKED TO GROUP PTAN IE881A EFFECTIVE 08/01/2015
FL
Enumeration date
08/19/2005
Last updated
05/05/2025
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us