Provider Demographics
NPI:1306156062
Name:ROBERT P. THOMPSON JR. MD PA
Entity type:Organization
Organization Name:ROBERT P. THOMPSON JR. MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:VANHOY
Authorized Official - Suffix:
Authorized Official - Credentials:CSA
Authorized Official - Phone:979-299-0011
Mailing Address - Street 1:201 OAK DR S
Mailing Address - Street 2:SUITE 108
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5676
Mailing Address - Country:US
Mailing Address - Phone:979-299-0011
Mailing Address - Fax:979-299-0022
Practice Address - Street 1:201 OAK DR S
Practice Address - Street 2:SUITE 108
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5676
Practice Address - Country:US
Practice Address - Phone:979-299-0011
Practice Address - Fax:979-299-0022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8862208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0970873-02Medicaid
00945GOtherMEDICARE ID
00945GOtherMEDICARE ID