Provider Demographics
NPI:1205942497
Name:THOMPSON, STEVEN HOWARD (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:HOWARD
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 1:497 SAINT MICHAELS WAY
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-7250
Mailing Address - Country:US
Mailing Address - Phone:972-722-0162
Mailing Address - Fax:
Practice Address - Street 1:12222 N CENTRAL EXPY
Practice Address - Street 2:SUITE 300
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3755
Practice Address - Country:US
Practice Address - Phone:972-270-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2012-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0949207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8M6312OtherBC BS OF TX
TX144832603Medicaid
TX48643200OtherDEPT OF LABOR
TX8B4769Medicare PIN
TX8M6312OtherBC BS OF TX