Provider Demographics
NPI:1528013737
Name:THIGPEN, D CROCKETT III (MD)
Entity Type:Individual
Prefix:
First Name:D
Middle Name:CROCKETT
Last Name:THIGPEN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:700 WALTER REED BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-3701
Mailing Address - Country:US
Mailing Address - Phone:972-487-5462
Mailing Address - Fax:972-487-5277
Practice Address - Street 1:700 WALTER REED BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-3701
Practice Address - Country:US
Practice Address - Phone:972-487-5462
Practice Address - Fax:972-487-5277
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL7216207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J0624OtherBCBS
TX165899901Medicaid
TX8B7622Medicare PIN
TXI05253Medicare UPIN