Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | H1851 | TX |
N | 208600000X | Surgeon | H1851 | TX |
Y | 208800000X | Urologist | H1851 | TX |
NPI | 1033126933 |
---|---|
Provider Name | Ian M Thompson JR. |
First Address | San Antonio, TX 78229-3901 |
Second Address | San Antonio, TX 78229-4427 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 13/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
020045334 | RAILROAD MEDICARE (01) | TX |
101670103 | (05) | TX |
101670104 | CSHCN (01) | TX |