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Individual

GLEN THOMPSON III

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
CSA

Contact information

Practice address
138 RAVEN DR, BEREA, KY 40403
(859) 200-3356
(502) 451-9291
Mailing address
138 RAVEN DR, BEREA, KY 40403
(859) 200-3356
(502) 451-9291

Taxonomy

Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
2222
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000493588
ANTHEM
KY
Enumeration date
05/01/2007
Last updated
07/08/2007
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