Provider Demographics
NPI:1043296957
Name:THOMPSON, GREGORY L (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:L
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 PLAYERS CLUB PKWY STE 350
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-8949
Mailing Address - Country:US
Mailing Address - Phone:901-207-2032
Mailing Address - Fax:844-752-2164
Practice Address - Street 1:1100 BELK BLVD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655
Practice Address - Country:US
Practice Address - Phone:662-232-8100
Practice Address - Fax:662-513-1496
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24465207L00000X
MS21416207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR127556001Medicaid
MO207821406Medicaid
TN3077001OtherBLUECROSS BLUESHIELD
TN3077737Medicaid
50046030OtherMEDICARE RAILROAD
MS00125621Medicaid
AR97195OtherBLUECROSS BLUESHIELD
TNF64802Medicare UPIN
50046030OtherMEDICARE RAILROAD