Provider Demographics
NPI:1194749101
Name:THOMPSON, MANDY M (MD)
Entity type:Individual
Prefix:DR
First Name:MANDY
Middle Name:M
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2407 AUBURN AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-3804
Mailing Address - Country:US
Mailing Address - Phone:214-319-2501
Mailing Address - Fax:
Practice Address - Street 1:3900 S STONEBRIDGE DR STE 1404
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070
Practice Address - Country:US
Practice Address - Phone:214-379-4234
Practice Address - Fax:214-453-2142
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9579207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX118524102Medicaid
TX110190424OtherRR MEDICARE