Provider Demographics
NPI:1902037948
Name:THOMPSON, JAMES G (LO, LPA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:G
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:LO, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 N LOY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-2529
Mailing Address - Country:US
Mailing Address - Phone:903-893-5696
Mailing Address - Fax:903-983-5332
Practice Address - Street 1:3737 N LOY LAKE RD
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2529
Practice Address - Country:US
Practice Address - Phone:903-893-5696
Practice Address - Fax:903-983-5332
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0108854-01Medicaid