Provider Demographics
NPI:1194798058
Name:THOMPSON, CHARLES W IV (PAC)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:W
Last Name:THOMPSON
Suffix:IV
Gender:M
Credentials:PAC
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Mailing Address - Street 1:8449 W BELLFORT ST
Mailing Address - Street 2:STE 140-A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77071
Mailing Address - Country:US
Mailing Address - Phone:713-777-8100
Mailing Address - Fax:713-777-8103
Practice Address - Street 1:8449 W BELLFORT ST
Practice Address - Street 2:STE 140-A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77071
Practice Address - Country:US
Practice Address - Phone:713-777-8100
Practice Address - Fax:713-777-8103
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2007-11-16
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Provider Licenses
StateLicense IDTaxonomies
TXPA00537363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant