Individual
BRYAN T THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
1590 E POLSTON AVE, STE A, POST FALLS, ID 83854
(208) 777-9794
(208) 777-9523
Mailing address
1590 E POLSTON AVE, STE A, POST FALLS, ID 83854
(208) 777-9794
(208) 777-9523
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
P173
ID
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
P-173
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010149213
BLUE SHIELD OF IDAHO
ID
05
—
807068300
—
ID
01
—
I0007985456
AETNA
ID
01
—
P9293
BLUE CROSS
ID
Enumeration date
07/28/2005
Last updated
01/24/2014
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