Basic Information
| Provider Information | |||||||||
| NPI: | 1326092131 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | TODD | ||||||||
| MiddleName: | PALMER | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1725 E BOULDER ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809095768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7193656300 | ||||||||
| FaxNumber: | 7193656094 | ||||||||
| Practice Location | |||||||||
| Address1: | 1725 E BOULDER ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809095768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7193656300 | ||||||||
| FaxNumber: | 7193656094 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 03/24/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 11135 | HI | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | DR-50583 | CO | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 77050860 | 05 | CO | MEDICAID |