Individual
DR. WILLARD RAY THOMPSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
530 CORPORATE CIR, SALISBURY, NC 28147-8074
(704) 637-0158
(704) 637-7710
Mailing address
6035 FAIRVIEW RD, CHARLOTTE, NC 28210-3256
(704) 295-3000
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
17741
NC
207Y00000X
Otolaryngology Physician
Primary
17741
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02606
BCBS PROVIDER ID
NC
01
—
30158896
SELECT HEALTH OF SC
SC
01
—
4412228
AETNA
NC
01
—
83198
BCBSNC
NC
05
—
8902606
—
NC
01
—
P01259200
RAILROAD MEDICARE
NC
05
—
Q17741
—
SC
Enumeration date
09/27/2005
Last updated
04/17/2014
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