Individual
PETER THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1111 CRATER LAKE AVE, MEDFORD, OR 97504-6241
(541) 732-5545
(541) 732-5548
Mailing address
PO BOX 708850, SANDY, UT 84070-8850
(866) 869-2397
(801) 352-9502
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD19883
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
044797
—
OR
05
—
210965
—
AZ
01
—
838334015
BCBS-ROSEBURG
OR
01
—
8584463012
BCBS-MEDFORD
OR
01
—
858464010
BCBS-SPRINGFIELD
OR
01
—
P00061232
RR MEDICARE
OR
01
—
R134117
MEDICARE-TYPE UNSPECIFIED
OR
Enumeration date
03/31/2006
Last updated
05/12/2008
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