Provider Demographics
NPI:1003021593
Name:THOMPSON, CARLA JEANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:JEANNE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:JEANNE
Other - Last Name:BOSWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5625 EIGER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-8982
Mailing Address - Country:US
Mailing Address - Phone:512-892-7076
Mailing Address - Fax:512-899-8460
Practice Address - Street 1:12600 HILL COUNTRY BLVD
Practice Address - Street 2:SUITE R-103
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-6723
Practice Address - Country:US
Practice Address - Phone:713-392-3055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3346208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX384496YLCDMedicare PIN