Provider Demographics
NPI:1942304167
Name:THOMPSON, GREGORY WILKINS (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:WILKINS
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14615 SAN PEDRO
Mailing Address - Street 2:200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232
Mailing Address - Country:US
Mailing Address - Phone:210-494-5192
Mailing Address - Fax:210-494-7011
Practice Address - Street 1:14615 SAN PEDRO
Practice Address - Street 2:200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232
Practice Address - Country:US
Practice Address - Phone:210-494-5192
Practice Address - Fax:210-494-7011
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD8457207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C22649Medicare UPIN
00BM49Medicare ID - Type Unspecified