Provider Demographics
NPI:1366587339
Name:THOMPSON, ALBERT P (MD)
Entity type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:P
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38505 BROOTEN RD
Mailing Address - Street 2:
Mailing Address - City:PACIFIC CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97135
Mailing Address - Country:US
Mailing Address - Phone:503-965-6555
Mailing Address - Fax:503-965-6800
Practice Address - Street 1:38505 BROOTEN RD
Practice Address - Street 2:SUITE A
Practice Address - City:PACIFIC CITY
Practice Address - State:OR
Practice Address - Zip Code:97135
Practice Address - Country:US
Practice Address - Phone:503-965-6555
Practice Address - Fax:503-965-6800
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD13058207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR129788Medicaid
ORC93934Medicare UPIN
OR129788Medicaid