Provider Demographics
NPI:1215986195
Name:THOMPSON, WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4777 US HIGHWAY 259
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-7668
Mailing Address - Country:US
Mailing Address - Phone:800-318-5578
Mailing Address - Fax:903-663-9960
Practice Address - Street 1:7502 GREENVILLE AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3802
Practice Address - Country:US
Practice Address - Phone:800-318-5578
Practice Address - Fax:903-663-9960
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL20292085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172621804Medicaid
TX145694901Medicaid
TX172621804Medicaid
TX145694901Medicaid
TX8D3427Medicare PIN
TX85786RMedicare PIN