Provider Demographics
NPI:1902173040
Name:DR. MATTHEW THOMPSON PLLC
Entity Type:Organization
Organization Name:DR. MATTHEW THOMPSON PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:940-600-7425
Mailing Address - Street 1:2625 SCRIPTURE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-2301
Mailing Address - Country:US
Mailing Address - Phone:940-600-7425
Mailing Address - Fax:866-348-7555
Practice Address - Street 1:2625 SCRIPTURE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2301
Practice Address - Country:US
Practice Address - Phone:940-600-7425
Practice Address - Fax:866-348-7555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3405207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty