Provider Demographics
NPI:1528135860
Name:THOMPSON, TANNA M (MD)
Entity type:Individual
Prefix:DR
First Name:TANNA
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:PO BOX 1219
Mailing Address - Street 2:
Mailing Address - City:BURNET
Mailing Address - State:TX
Mailing Address - Zip Code:78611-7219
Mailing Address - Country:US
Mailing Address - Phone:512-715-3110
Mailing Address - Fax:512-715-0678
Practice Address - Street 1:200 COUNTY ROAD 340A
Practice Address - Street 2:BLDG I, SUITE A
Practice Address - City:BURNET
Practice Address - State:TX
Practice Address - Zip Code:78611-4537
Practice Address - Country:US
Practice Address - Phone:512-715-3110
Practice Address - Fax:512-715-0678
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0650208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics