Provider Demographics
NPI:1003801119
Name:THOMPSON, ROBERT POOL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:POOL
Last Name:THOMPSON
Suffix:JR
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 1:1180 SETON PKWY STE 150
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-6319
Mailing Address - Country:US
Mailing Address - Phone:512-407-8686
Mailing Address - Fax:855-213-8218
Practice Address - Street 1:1180 SETON PKWY STE 150
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-6319
Practice Address - Country:US
Practice Address - Phone:512-504-0877
Practice Address - Fax:855-213-8218
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2019-01-14
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
TXH8862208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX097087305Medicaid
TX097087302Medicaid
TX097087304Medicaid
TX00945GMedicare ID - Type Unspecified
TXE88167Medicare UPIN
TX097087304Medicaid
TX097087305Medicaid