Provider Demographics
NPI:1063479434
Name:THOMPSON, MAYRA J (MD)
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:J
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12201 MERIT DR STE 300
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-3139
Mailing Address - Country:US
Mailing Address - Phone:972-528-5590
Mailing Address - Fax:972-905-1688
Practice Address - Street 1:12201 MERIT DR STE 300
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-3139
Practice Address - Country:US
Practice Address - Phone:972-528-5590
Practice Address - Fax:972-905-1688
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6186207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG6186OtherCOMMERCIAL INSURANCE
TX114923904Medicaid
TX114923904Medicaid