Provider Demographics
NPI:1669891982
Name:THOMPSON, MALLORY KIMBELL
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:KIMBELL
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12709 TOEPPERWEIN RD STE 309
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3260
Mailing Address - Country:US
Mailing Address - Phone:106-574-0992
Mailing Address - Fax:210-599-9137
Practice Address - Street 1:12709 TOEPPERWEIN RD STE 309
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3260
Practice Address - Country:US
Practice Address - Phone:106-574-0992
Practice Address - Fax:210-599-9137
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR7614207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology