Provider Demographics
NPI:1548200785
Name:THOMPSON, PAUL DAVID (M D)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DAVID
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5408 BIRCHMAN AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-5111
Mailing Address - Country:US
Mailing Address - Phone:817-731-1952
Mailing Address - Fax:817-731-1955
Practice Address - Street 1:5408 BIRCHMAN AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-5111
Practice Address - Country:US
Practice Address - Phone:817-731-1952
Practice Address - Fax:817-731-1955
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5H02208800000X
TXM8385207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO383087OtherHEALTHLINK
MO0296520001OtherMEDICARE SUPPLIER (DMERC)
MO23237OtherBLUE CROSS BLUE SHIELD
MO0296520001OtherMEDICARE SUPPLIER (DMERC)