Provider Demographics
NPI:1659310175
Name:THOMPSON, WILL DONN (MPAS, PA-C)
Entity Type:Individual
Prefix:MR
First Name:WILL
Middle Name:DONN
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 2070
Mailing Address - Street 2:
Mailing Address - City:ORANGE GROVE
Mailing Address - State:TX
Mailing Address - Zip Code:78372-2070
Mailing Address - Country:US
Mailing Address - Phone:361-382-2024
Mailing Address - Fax:855-606-6314
Practice Address - Street 1:101 S EUGENIA ST
Practice Address - Street 2:
Practice Address - City:ORANGE GROVE
Practice Address - State:TX
Practice Address - Zip Code:78372-2309
Practice Address - Country:US
Practice Address - Phone:361-382-2024
Practice Address - Fax:855-606-6314
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA04256363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F2642Medicare ID - Type UnspecifiedPROVIDER NUMBER
TXQ65569Medicare UPIN
TX458927Medicare Oscar/Certification