Thompson, Mark Edmund
Thompson, Mark Edmund is an individual health care provider with primary practice located at 4520 W Us Highway 90 , Lake City FL 32055-8341. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Radiation Oncology, Allopathic & Osteopathic Physicians / Therapeutic Radiology. Allopathic & Osteopathic Physicians / Therapeutic Radiology is his primary health care specialty. Thompson, Mark Edmund can be contacted via phone (352) 755-0601.Contact Information
Primary practice address
4520 W Us Highway 90
Lake City FL 32055-8341
Phone: (352) 755-0601
Fax: (352) 755-0602
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Radiation Oncology | 2085R0001X | OS10194 | Florida |
| Allopathic & Osteopathic Physicians / Therapeutic Radiology | 2085R0203X | OS10194 | Florida |
Profile Details
| NPI number | 1487646030 |
|---|---|
| LBN Legal business name | Thompson, Mark Edmund |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 19th, 2005 |
| Last updated | Feb 16th, 2023 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1487646030 | NPPES |
| Florida | Other | 310302 | AVMED |
| Florida | MEDICAID | 279300800 | AVMED |
| Florida | MEDICAID | 0825156 | AVMED |
| Florida | Other | PTAN AG644E | AVMED |
| Florida | Other | 02484 | AVMED |
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