Provider Demographics
NPI:1619989266
Name:THOMPSON, MATTHEW DAVID (DO)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DAVID
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DO
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 270161
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75027-0161
Mailing Address - Country:US
Mailing Address - Phone:940-600-7425
Mailing Address - Fax:972-539-3038
Practice Address - Street 1:2625 SCRIPTURE ST.
Practice Address - Street 2:SUITE 101
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201
Practice Address - Country:US
Practice Address - Phone:940-600-7425
Practice Address - Fax:972-539-3038
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3405207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181420402Medicaid
TX181420403Medicaid
TX181420402Medicaid
TX8J8793Medicare PIN
TXI57915Medicare UPIN