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:
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Health care specialties

SpecialtyCodeLicense #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 3 years ago

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.

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Identifiers

StateTypeNumberIssuer
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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