Provider Demographics
NPI:1376551036
Name:THOMPSON, RICHARD F JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:F
Last Name:THOMPSON
Suffix:JR
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:P.O. BOX 849722
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-9722
Mailing Address - Country:US
Mailing Address - Phone:615-306-0926
Mailing Address - Fax:713-877-0970
Practice Address - Street 1:217 NORTH CEDAR AVENUE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2418
Practice Address - Country:US
Practice Address - Phone:615-306-0926
Practice Address - Fax:713-877-0970
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000027181103T00000X
VA01012552832084P0800X
TXU07382084P0800X
SC403522084P0800X
COCDR.00024652084P0800X, 2084P0802X, 2084P0805X
DEC1-00263512084P0800X
NC2016-000332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3374755Medicare ID - Type UnspecifiedMEDICARE RENDERING ID
TN3096281Medicare ID - Type UnspecifiedMEDICARE GROUP ID