Individual
CHARLES ALLEN THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6550 MAIN STREET, SUITE 1000, ZACHARY, LA 70791-4079
(225) 654-1559
(225) 654-6212
Mailing address
PO BOX 4176, HOUMA, LA 70361-4176
(985) 876-0300
(985) 872-0317
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
10749R
LA
207RI0011X
Interventional Cardiology Physician
Primary
10749R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1666840
—
LA
01
—
P00398472
RR MEDICARE
LA
Enumeration date
06/05/2007
Last updated
10/19/2015
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