Provider Demographics
NPI:1518980465
Name:THOMPSON, PATRICIA D (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:D
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 1:6875 FM 1488 RD STE 1400
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-4526
Mailing Address - Country:US
Mailing Address - Phone:281-259-9032
Mailing Address - Fax:281-259-9142
Practice Address - Street 1:6875 FM 1488 RD STE 1400
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-4526
Practice Address - Country:US
Practice Address - Phone:281-259-9032
Practice Address - Fax:281-259-9142
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP4621208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY110222955OtherRR MEDICARE PIN
KY64281231Medicaid
KY4000501OtherMEDICARE LAB GROUP
KY37903705OtherMEDICAID LAB GROUP
KYCB5773OtherRR MEDICARE GROUP
KY4000501OtherMEDICARE LAB GROUP
KY0624009Medicare ID - Type Unspecified
KY110222955OtherRR MEDICARE PIN