person
Tyler Bradshaw Thompson, IDC
Military Health Care Provider in San Diego, California
NPI 1083275762

Tyler Bradshaw Thompson is a Military Health Care Provider based in San Diego, CA. Tyler Bradshaw Thompson practices in San Diego, CA and has the professional credentials of IDC. The NPI Number for Tyler Bradshaw Thompson is 1083275762 and holds a License No. (California).

The current practice location address for Tyler Bradshaw Thompson is 34, Farenholt Ave, San Diego, CA and can be reached out via phone at 619-532-7962.

Location: 34, Farenholt Ave, San Diego, CA, 92108-5659
person
Provider Profile Details
NPI Number
1083275762
Provider Name
Tyler Bradshaw Thompson
Credential
IDC
Provider Entity Type
Individual
Gender
Male
Address
34, Farenholt Ave, San Diego, CA, 92108-5659
Phone Number
619-532-7962
Fax Number
Provider Enumeration Date
06/24/2019
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
59672019 01 MILITARY
institution
Provider Business Practice Location Address Details
Address
34, Farenholt Ave
City
State
Zip
92134-0001
Phone Number
619-532-7962
Fax Number
person
Provider Business Mailing Address Details
Address
34, Farenholt Ave
City
State
Zip
92134-0001
Phone Number
619-532-7962
Fax Number
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Military Health Care Provider
Speciality
-
Taxonomy
License No.
()
Definition
Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes.
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