Provider Demographics
NPI:1033259155
Name:THOMPSON, DOROTHY MAE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:MAE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 BOOTS DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-2794
Mailing Address - Country:US
Mailing Address - Phone:254-539-6101
Mailing Address - Fax:
Practice Address - Street 1:4310 BOOTS DR
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-2794
Practice Address - Country:US
Practice Address - Phone:254-539-6101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04163363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical