Provider Demographics
NPI:1720271265
Name:THOMPSON, IAN MURCHIE III (MD)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:MURCHIE
Last Name:THOMPSON
Suffix:III
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 3046
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-0746
Mailing Address - Country:US
Mailing Address - Phone:956-523-3090
Mailing Address - Fax:956-523-3083
Practice Address - Street 1:10710 MCPHERSON ROAD
Practice Address - Street 2:SUITE 104
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6363
Practice Address - Country:US
Practice Address - Phone:956-523-3090
Practice Address - Fax:956-523-3083
Is Sole Proprietor?:No
Enumeration Date:2007-08-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP3085208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX299329701Medicaid
TX299329701Medicaid