Provider Demographics
NPI:1952533168
Name:THOMPSON, LATRICIA M (MD)
Entity Type:Individual
Prefix:DR
First Name:LATRICIA
Middle Name:M
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18220 TOMBALL PKWY
Mailing Address - Street 2:SUITE 260
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-4347
Mailing Address - Country:US
Mailing Address - Phone:281-890-4448
Mailing Address - Fax:281-890-4237
Practice Address - Street 1:18220 TOMBALL PKWY
Practice Address - Street 2:SUITE 260
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4347
Practice Address - Country:US
Practice Address - Phone:281-890-4448
Practice Address - Fax:281-890-4237
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1471207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX214305902Medicaid
TX8FX492OtherBLUE CROSS BLUE SHIELD
TX214305903Medicaid
TXP01013107OtherRR MEDICARE
TX214305903Medicaid
TX345060ZSWDMedicare PIN