Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | 4035 | TX |
Y | 213ER0200X | Radiology | 4035 | TX |
NPI | 1538201538 |
---|---|
Provider Name | Dr. Jeffrey R Thompson |
First Address | Houston, TX 77080-3839 |
Second Address | Houston, TX 77080-3839 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2007 |
Last Update Date | 28/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
FTX101 | MEDICARE GROUP (01) | TX |
T79117 | (02) | TX |