Provider Demographics
NPI:1609853001
Name:THOMPSON-BELL, GWENDELL (MD)
Entity Type:Individual
Prefix:
First Name:GWENDELL
Middle Name:
Last Name:THOMPSON-BELL
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:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0853
Mailing Address - Country:US
Mailing Address - Phone:972-715-5000
Mailing Address - Fax:972-715-9976
Practice Address - Street 1:6606 LBJ FWY
Practice Address - Street 2:SUITE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240
Practice Address - Country:US
Practice Address - Phone:972-715-5000
Practice Address - Fax:972-715-9976
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2373207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01447015OtherRR
TX1243073012Medicaid
TX8EH569OtherBCBS
G13448Medicare UPIN
TX340853YK6UMedicare PIN
TX124307311OtherMEDICAID CSHCN
G13448Medicare UPIN
TX8370M0Medicare PIN
TX124307305Medicaid
TX8A4395OtherBCBS
TX050077627OtherRAILROAD
TX124307309OtherMEDICAID CSHCN
TX8227M6Medicare ID - Type Unspecified339K
TX124307308Medicaid