Provider Demographics
NPI:1366553935
Name:THOMPSON, LAUREE LYNELL (MD)
Entity type:Individual
Prefix:DR
First Name:LAUREE
Middle Name:LYNELL
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAUREE
Other - Middle Name:LYNELL
Other - Last Name:RIPPLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3195 DOWLEN RD STE 101
Mailing Address - Street 2:PMB 349
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-7272
Mailing Address - Country:US
Mailing Address - Phone:409-899-7890
Mailing Address - Fax:409-899-7363
Practice Address - Street 1:2830 CALDER ST
Practice Address - Street 2:NICU
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1809
Practice Address - Country:US
Practice Address - Phone:409-899-7890
Practice Address - Fax:409-899-7363
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL06492080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154016301Medicaid