Provider Demographics
NPI:1124150024
Name:THOMSON, DEBORAH ANN (PA-C)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:ANN
Last Name:THOMSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 N VETERANS BLVD
Mailing Address - Street 2:P.O. BOX 1470
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-3302
Mailing Address - Country:US
Mailing Address - Phone:830-773-6963
Mailing Address - Fax:830-757-5647
Practice Address - Street 1:1117 W DE LA ROSA ST
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-6224
Practice Address - Country:US
Practice Address - Phone:830-768-4800
Practice Address - Fax:830-768-4844
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03290363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111923201Medicaid
TX121077504Medicaid
TX121077505Medicaid
TX121077505Medicaid
TX8127J1Medicare ID - Type UnspecifiedGROUP