Provider Demographics
NPI:1265543714
Name:THOMPSON, JOHN HOWARD (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
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:PO BOX 2167
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-7167
Mailing Address - Country:US
Mailing Address - Phone:817-594-5496
Mailing Address - Fax:817-594-5497
Practice Address - Street 1:707 STATE ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5777
Practice Address - Country:US
Practice Address - Phone:817-594-5496
Practice Address - Fax:817-594-5497
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD8459208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX031847901Medicaid
75-1571003OtherEIN
TX031847901Medicaid
TXC22638Medicare UPIN