MEDICARE: DR. ANTHONY JUDE CALZADA THOMPSON DO

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	2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	34007355	OH
2	2083X0100X	Occupational Medicine Physician	N4156	TX
3	207QA0505X	Adult Medicine Physician	N4156	TX
4	207Q00000X	Family Medicine Physician	N4156	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639178205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY JUDE CALZADA THOMPSON DO

Provider Business Mailing Address
First Line	:	204 E 1ST ST
Second Line	:
City	:	ALICE
State	:	TX
Zip	:	78332-4822
Country	:	US
Telephone Number	:	361-664-0145
Fax Number	:	361-664-2478

Provider Business Practice Location Address
First Line	:	415 S 6TH ST
Second Line	:
City	:	KINGSVILLE
State	:	TX
Zip	:	78363-5518
Country	:	US
Telephone Number	:	361-664-0145
Fax Number	:	361-664-2479

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	03/11/2014

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