MEDICARE: KIDA THOMPSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	Q9530	TX

General Provider Information

NPI Number	:	1346504503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIDA THOMPSON MD

Provider Business Mailing Address
First Line	:	1390 GEORGE DIETER DR STE 110
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-7423
Country	:	US
Telephone Number	:	915-271-4640
Fax Number	:	915-271-4641

Provider Business Practice Location Address
First Line	:	1390 GEORGE DIETER DR STE 110
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-7423
Country	:	US
Telephone Number	:	915-271-4640
Fax Number	:	915-271-4641

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2012
Last Update Date	:	05/21/2019

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Directions to “ KIDA THOMPSON MD” Practice Location

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