Provider Demographics
NPI:1093764318
Name:THOMPSON, CHARLES A (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:A
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 1:4800 NE STALLINGS DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1249
Mailing Address - Country:US
Mailing Address - Phone:936-569-0000
Mailing Address - Fax:936-560-4932
Practice Address - Street 1:4800 NE STALLINGS DR
Practice Address - Street 2:SUITE 106
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1249
Practice Address - Country:US
Practice Address - Phone:936-569-0000
Practice Address - Fax:936-560-4932
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0115207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F2291Medicare ID - Type Unspecified