Individual
DR. SHELLY HOLDER THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
120 KING ST, JACKSONVILLE, FL 32204-2410
(904) 760-4904
(904) 760-4250
Mailing address
120 KING STREET, JACKSONVILLE, FL 32204-2410
(904) 760-4904
(904) 760-4250
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
ME0038917
FL
208000000X
Pediatrics Physician
Primary
ME38917
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0662089-00
—
FL
05
—
066208900
—
FL
Enumeration date
04/21/2006
Last updated
07/21/2022
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