Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | D8458 | TX |
N | 207QA0505X | Family Doctor - Adult Medicine | D8458 | TX |
NPI | 1104121052 |
---|---|
Provider Name | James Merwyn Thompson |
First Address | Goldthwaite, TX 76844-0508 |
Second Address | Goldthwaite, TX 76844 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2011 |
Last Update Date | 24/01/2011 |