Provider Demographics
NPI:1992749345
Name:THOMPSON, SANFORD R JR (MD)
Entity type:Individual
Prefix:
First Name:SANFORD
Middle Name:R
Last Name:THOMPSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:201 OAK DR S
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5676
Mailing Address - Country:US
Mailing Address - Phone:979-297-3004
Mailing Address - Fax:979-299-1301
Practice Address - Street 1:201 OAK DR S
Practice Address - Street 2:SUITE 104
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5676
Practice Address - Country:US
Practice Address - Phone:979-297-3004
Practice Address - Fax:979-299-1301
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD7333207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
202900086OtherRAILROAD MEDICARE
TX145702001Medicaid
8328MOMedicare PIN
C22645Medicare UPIN
0887970001Medicare NSC