Provider Demographics
NPI:1942348727
Name:THOMPSON, BRUCE F (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:F
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2032 S 17TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-6678
Mailing Address - Country:US
Mailing Address - Phone:910-763-3738
Mailing Address - Fax:910-763-0454
Practice Address - Street 1:2032 S 17TH ST STE 101
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6678
Practice Address - Country:US
Practice Address - Phone:910-763-3738
Practice Address - Fax:910-763-0454
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2022-00204207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY687964OtherUNITED HEALTHCARE
NYCP575OtherOXFORD ID#
NY46031OtherVYTRA ID #
NY166049-1OtherWORKERS COMPENSATION
NY134AU1OtherBLUE CROSS BLUE SHIELD
NY166049-1OtherLICENSE #
NY166049-1Medicaid
NY061638829OtherTAX ID #
NYCP575OtherOXFORD ID#
NY46031OtherVYTRA ID #