Provider Demographics
NPI:1477887313
Name:THOMPSON, J. DAVID (MD)
Entity Type:Individual
Prefix:
First Name:J.
Middle Name:DAVID
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 1:2020 W STATE HIGHWAY 114
Mailing Address - Street 2:SUITE 110
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-8649
Mailing Address - Country:US
Mailing Address - Phone:817-310-0810
Mailing Address - Fax:817-812-3525
Practice Address - Street 1:2020 W STATE HIGHWAY 114
Practice Address - Street 2:SUITE 110
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-8649
Practice Address - Country:US
Practice Address - Phone:817-310-0810
Practice Address - Fax:817-812-3525
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19257207X00000X, 207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL19257OtherMEDICAL LICENSE
MO2000158344OtherMEDICAL LICENSE