MEDICARE: DANA SHERMAN THOMPSON PA-C

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	363AM0700X	Medical Physician Assistant	PA12560	TX

General Provider Information

NPI Number	:	1508321878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA SHERMAN THOMPSON PA-C

Provider Business Mailing Address
First Line	:	501 PEDEN ST APT 3
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77006-1449
Country	:	US
Telephone Number	:	651-357-6158
Fax Number	:

Provider Business Practice Location Address
First Line	:	2350 ATASCOCITA RD
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77396-3503
Country	:	US
Telephone Number	:	651-357-6158
Fax Number	:

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

Provider Enumeration Date	:	01/31/2019
Last Update Date	:	01/31/2019

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