Provider Demographics
NPI:1194460543
Name:THOMPSON, TREVOR (DO)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 DOOLITTLE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76127-1133
Mailing Address - Country:US
Mailing Address - Phone:817-782-5900
Mailing Address - Fax:
Practice Address - Street 1:1711 DOOLITTLE AVE
Practice Address - Street 2:
Practice Address - City:NAVAL AIR STATION JRB
Practice Address - State:TX
Practice Address - Zip Code:76127-1133
Practice Address - Country:US
Practice Address - Phone:817-782-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-30
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider