Provider Demographics
NPI:1043326788
Name:THOMPSON, LYNN ELLIOTT (MD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:ELLIOTT
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 1:919 HIDDEN RDG
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3813
Mailing Address - Country:US
Mailing Address - Phone:469-282-2711
Mailing Address - Fax:469-282-2609
Practice Address - Street 1:2020 SUNDANCE PKWY
Practice Address - Street 2:SUITE A1
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-2770
Practice Address - Country:US
Practice Address - Phone:830-625-7748
Practice Address - Fax:830-625-2563
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4601207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP02587380OtherMEDICARE RAILROAD
TX111711102Medicaid
TX888772OtherBLUE CROSS/BLUE SHIELD
TX111711101Medicaid
TX111711104Medicaid
TX1G7459OtherMEDICARE
TX111711102Medicaid