Basic Information
Provider Information | |||||||||
NPI: | 1306036942 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | THOMPSON | ||||||||
FirstName: | JONATHAN | ||||||||
MiddleName: | DEAN | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 10101 PARK ROWE AVE STE 200 | ||||||||
Address2: |   | ||||||||
City: | BATON ROUGE | ||||||||
State: | LA | ||||||||
PostalCode: | 708101685 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2257692200 | ||||||||
FaxNumber: | 2257682185 | ||||||||
Practice Location | |||||||||
Address1: | 19065 DR JOHN LAMBERT DR STE 2000-B | ||||||||
Address2: |   | ||||||||
City: | HAMMOND | ||||||||
State: | LA | ||||||||
PostalCode: | 704030997 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2257692200 | ||||||||
FaxNumber: | 2257682185 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/30/2007 | ||||||||
LastUpdateDate: | 05/20/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/20/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 201144 | LA | N |   | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |   | 208VP0014X | 201144 | LA | Y |   | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
No ID Information.