Individual
DR. KYLE G THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2100 PROVIDENCE WAY, IDAHO FALLS, ID 83404-6236
(208) 529-6600
(208) 529-6602
Mailing address
2100 PROVIDENCE WAY, IDAHO FALLS, ID 83404-4951
(208) 529-6600
(208) 529-6602
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
M-12830
ID
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
M12830
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1710111224
—
ID
Enumeration date
05/12/2009
Last updated
11/05/2020
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